Tough challenges on the horizon

I hate to be a downer, but from where I sit, next year's shaping up to be pretty scary for providers.

For one thing, several leading health plans have vowed to raise premiums in 2009. As we've discussed here previously, this is sure to drive some employers to cut benefits and others to drop health coverage entirely. Ultimately, this means more bills patients can't pay.

Meanwhile, with financial markets still recovering from subprime losses, providers haven't been able to count on investment income this year to cover the gaps in their own income. Next year may not be much better.

Then, there's the gridlock that's likely to take effect after the presidential election for at least the first six months or so, regardless of which party wins the day. Lobbyists are doubtless hoping to get their final licks in now--on critical issues like the planned 10 percent Medicare cut for doctors--but there's only so much they can get done before November.

The only real question mark here, in my view, is whether federal officials will spend more money in the near term to help hospitals and doctors pay for electronic medical records.

They might. After all, the Bush administration is terribly gung-ho on the subject. That could at least provide some welcome capital for a critical, capital-intensive project most hospitals have underway or planned for the near term.

Otherwise, as I see it, this is a time for living on a shoestring for a while if there ever was one. Disagree? Drop me a line and let me know what you think. - Anne