For our November print issue, we asked local experts to gaze into the crystal ball to predict what life in the Little Rock metro area will be like in 2050.

The health care industry consumes one in five U.S. dollars — more than citizens spend on health care in any other country. This means policy change in health care is often incremental. Attempts at major change clash with deep-pocketed interests seeking to maintain the status quo or even enhance profit margins.


In my view, only two major legislative efforts have truly disrupted health care in the last six decades: the advent of Medicare and Medicaid with the Social Security Act of 1965 and the expansion of health care coverage with the Patient Protection and Affordable Care Act of 2010. These are big changes, but the way that Arkansans access health care coverage — through Medicare for older adults, Medicaid for those who are low-income or disabled, and employer-sponsored coverage for those who are employed — has remained largely unchanged.

Over the same period, however, clinical and technological advancements have far outpaced health care policy. Today, patients can check lab results through an online portal, consult with a doctor through video-conferencing on their lunch break, and access their medical records on their phone. The number and types of treatment available for health conditions are expansive, and breakthrough therapies for both rare and common diseases are arriving more frequently as long-term investments in research and clinical trials show promise. These changes are much harder to predict, so I offer a couple of safe predictions and a couple of bold ones.


In the safe (and maybe obvious) category:

*Most mental health therapy will be delivered remotely, with the therapist at one location and the patient at another location. Until the COVID-19 pandemic arrived in 2020, in some practices remote therapy was primarily used to accommodate patients with mobility issues or scheduling challenges, or to supplement a therapist’s practice with evening or weekend hours. Patient demand is now making remote therapy a more integral and necessary part of practice.


*Misinformation will corrupt the delivery of health care services, much as it has the protection of public health during the pandemic. I wish I could be more optimistic about this, but the level of attention garnered by ivermectin and hydroxychloroquine as purported treatments for COVID-19 is a symptom of a larger problem. “Seeking a second opinion” on a course of treatment is an age-old adage, but when that second opinion comes from social media or other disreputable sources, poor outcomes are inevitable.

In the bold category:

*Few, if any, employers will offer health insurance. First offered as an incentive to attract employees in the 1940s when it was very low cost, health insurance is no longer as attractive for employers. Rising health care costs reflected in insurance premiums eat away at resources to pay wages. This will reach a boiling point sometime in the next decade, and employers will demand regulatory flexibility to offer defined contributions or be free altogether from offering health insurance. This will, of course, open up a new benefit market for attracting employees.

*Online retail conglomerates, such as Walmart and Amazon, will make strong moves into health insurance markets and health care delivery. I know I am not alone when I admit that the convenience of a one-stop shop for all of my needs — and particularly the idea of discounts for “bundled services,” whether perceived or real — is very attractive. Online retailers are savvy at using these techniques to appeal to consumers. I can foresee an online retailer with a “whole health” product that includes discounts on health insurance or doctor visits for purchases of healthy foods, diet products, running shoes, gym memberships or smaller clothing sizes as evidence of weight loss. To be sure, I am neither endorsing this idea nor saying that it is consistent with current law, but it’s not entirely impossible.


Putting aside the soothsaying, I am certain of two things. First, we will look back in 30 years and know that the COVID-19 pandemic forever changed the health care industry, particularly in the devastation it wrought on the health workforce pipeline. Second, absent a reversal in obesity trends, we are destined for increased morbidity, disability and death. I remain hopeful that a reversal can happen, but everyone will have to play a role — individuals and families, schools, communities, the food industry and local, state and federal policymakers — and the solution must include a focus on addressing underlying social needs and creating an environment in which the healthy choice is the available, convenient and affordable choice for all.

Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock.