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The Keckley Report

What do Millennials want from the Health System? The Three Imperatives

By March 17, 2014March 1st, 2023One Comment


The 18-34 year old segment of our population is a large, growing and important in our society. There are 80 million strong. Their attitudes, beliefs, values and actions are re-shaping the way every organization, business and institution thinks about its future.  

According to a Pew Research report released last week, Millennials are independents and skeptics: 50% have no political affiliation, 29% no religious affiliation, and 19% say they do not trust established institutions to do the right things (versus 40% for Baby Boomers).

Millennials worry about money. A study by the

Investor Education Foundation of the Financial Industry Regulatory Authority concluded they concerns about their about auto, credit card and school debt trumps other issues. Most think economic stability should come before marriage and family life. Half who went to college have a student loan to repay, and one third moved into the homes of their parents at some point to make ends meet.

And they worry about the future. Paul Taylor’s The Next America: Boomers, Millennials, and the Looming Generational Showdown predicts economic battle between Millennials and Baby Boomers: “Every family, on some level, is a barter between the generations…If I care for you when you’re young so you’ll care for me when I’m old…But many Millennials won’t be able to afford that…The young today are paying taxes to support a level of benefits for the old that they themselves have no prospect of receiving when they become old.”  Pew survey data supports his contention: 

  • 51% of Millennials do not think there will be any money for them in the Social Security system by the time they retire.
  •  39% believe they’ll get reduced benefits

So what do Millennials want from the health system? Their view is likely to disrupt how industry leaders operate their businesses and how policymakers make laws that govern its commerce. Like the economy and financial matters, their knowledge about the health system is somewhat lacking in specifics, but their opinions are rooted in three strongly held beliefs espoused by the majority in their ranks who regard them as imperatives:

Make it about health. Millennials think the U.S. healthcare system is fundamentally flawed. They believe it is purposely geared toward the sickest and oldest, and structured to profit from their treatment. They want a system of health that balances resources for the young and healthy with compassionate care for the elderly and sick. They want a system that pays for a blend of mind-body therapies, embraces healthy food, clean air and spirituality as central elements alongside medicines, and allows individuals to make choices at the beginning and end of their lives. They want a system wherein preventive health and primary care is holistic, widely accessible, and respected as a reflection of a community’s core values. And they believe incentives should reward healthiness in lieu of volume for procedures, testing and drugs. They see a sick care system; they want a health system.

Make it simple: Millennials approach life through the lens of the micro-communities where they live, work and recreate. They are dependent on iPhones, NetFlix, iTunes and social media, and are pre-disposed against big government, big business, big religion, big politics and big healthcare. They want a local health care system that’s simple: paperless, treatments that are necessary and easily understood, prices that are sensible and transparent, and caregivers who listen and connect. Most prefer to pay a reasonable single payment monthly to cover everything–no co-pays, deductibles, premiums and out of pocket for what’s not covered. And many think a single payer, government run system might be more easy to navigate than the hodge-podge of programs and plans they see at work and in their community.

Make it accessible: Millennials think healthcare is a right, not a privilege for those of means. They believe basic healthcare should be the same for all; they believe profits should be subordinate to its purpose. They want ownership of their medical record, information about the clinical outcomes and financial incentives of their caregivers, and ubiquitous access to health information through their mobile devices. They want services that are coordinated and a solution to the menacing gaps in care for those lacking insurance. And they want an end to the intramural jousting over the future of the health system between primary care and specialty clinicians, hospitals and private insurers, Republicans and Democrats, and other warring factions.

Last week, with a group of health executives, I visited the campus of Zappos in Las Vegas where 1500 Millennials live and work operating a successful online apparel marketplace recently acquired by Amazon. Its business is a means to and end; its purpose is to create a culture of connectivity and service that rewards individual and collective efforts that make their community happier, healthier, and productive. Its Downtown Project is not about economic development; it’s about people living together to meet common needs including healthcare.

Millennials are not a homogenous population, but their voices about healthcare seem consistent and in unison The Zappos faithful are not too different from the ranks of their youthful peers in every community in America. They are watching the journeys of their parents and grandparents through endless paperwork, inexplicable costs, non-responsive providers and insurance that seems geared more to profit than coverage. They know the system of care in the U.S. is better for those with private insurance than for those without, and they know health reform is political quicksand for well-intended policymakers seeking to correct its fundamental flaws.

Health matters to Millennials. They want a health system that’s different than the status quo. Those who choose to dismiss their views as naïve or ill-informed should reconsider. This generation is reshaping the landscape in our society one industry at a time. It’s likely healthcare will be among them. And their imperatives about its future will be heard.        

Health industry news from last week..

Affordable Care Act:

  • Health exchange enrollment at end of February: Monday, the White House released its latest figures: 4.2 million total enrollment; 13 states above their enrollment targets; 83% of enrollees have chosen a silver plan. (Note: Avalere estimate last week said March 31 enrollment will be 5.4 million; Keckley Report in January estimated 5.5 million)
  • ACA Popularity: The Affordable Care Act played a key role in Tuesday’s special election in the Clearwater FL 13th District Congressional election.  Rep.-elect David Jolly (R) beat Democrat Alex Sink 48.4%-46.6%. A Wall Street Journal/NBC News poll showed that 47% of voters say they would be more likely to vote for a candidate who supports repeal — like Jolly — compared to 32% who say they are less likely. When it comes to candidates who support keeping and fixing the health-care law — like Sink — voters are split, with 45 percent saying they would be more likely to vote for such a candidate and 42 percent saying they would be less likely to do so.
  • Sebellius testimony in House Ways and Means: Last Wednesday, HHS Secretary Kathleen Sebellius testified that the March 31 deadline for enrollment in the health exchanges for individuals would not be delayed but declined to speculate about the final enrollment.  She told the committee to expect higher insurance premiums in 2015, but at a slower pace than in prior years. between 18-34.
  • Deadline extension for high-risk pool: Friday, the administration announced it was extending the deadline for enrollment in the temporary Pre-Existing Condition Insurance Plan (PCIP) set to expire March 31. The program covers people who traditionally had trouble affording or finding individual insurance because of a medical condition. The extension is available to PCIP enrollees (21,000 currently covered) who haven’t yet enrolled in another health plan. They have until April 15 to enroll in new coverage that starts May 1.

Corporate strategies:

  • Castlight Health IPO: (CSLT): The company offers health information via the Internet to inform medical choices and reduce insurance costs and generated $13 million in revenues last year. Goldman Sachs, Morgan Stanley and other lead underwriters priced shares at $16, above expected range of $13 to $15, giving the company a valuation of $1.4 billion. The stock opened Friday at $39, giving it a valuation of over $3 billion. Note: the prior 13 deals priced at 100 times revenue or more and sales of at least $10 million has an average 3-year return was -92%.
  • Healthy food: Dannon announced it was overhauling its food options to reduce fat and sugar content in tandem with the First Lady’s Partnership for a Healthier America Project. Previously, Darden and Subway announced similar efforts.


  • Total joint: More than 7,000,000 Americans have artificial joints (Mayo Clinic study presented at American Academy of Orthopedic Surgeons Annual meeting in New Orleans last week)


  1. Blood test for Alzheimer’s: A new test was used to predict with 90% accuracy Alzheimer’s in older adults wherein 10 fats were found in their bloodstream. (Nature Medicine) 


  • Specialty Drug Coverage: The Virginia family of 7-year-old Josh Hardy is using social media to convince Chimerix of Durham, NC to make anti-viral drug (brincidofovir) available to keep their son alive under provisions of “compassionate use”.
  • Docs encourage FDA to allow MS drug it previously denied: Last week, 70 doctors published a letter to the FDA in Lancet encouraging its accelerated approval of Lemtrada (Genzyme). In November, the FDA rejected its approval though it had clearance approvals in Europe, Canada, New Mexico, and Australia
  • Biosimilars protection in trade pact: The administration, in negotiating its 12 nation Trans Pacific Partnership, is seeking increased access for logistics, consulting firms, and drug companies, but regulations around biotechnology, especially biosimilars, is mired in uncertainty. The Affordable Care Act gave biotech companies an additional 12 years of “data exclusivity” i.e. the results of tests used in developing the drug cannot be referenced or relied on by companies trying to develop generic substitutes for 12 years after the original drug’s approval. But the FDA is still working out the details of this policy, and the first generics (biosimilars) are years away. The TPP would require the US to determine how to protect its biotech interests in its countries like Vietnam and others where intellectual property protections in the biosciences have not been strictly enforced.

Health insurance plans:

  • Narrowing networks: 70% of hospital networks on exchanges are narrow, and 38% are very narrow (McKinsey)·     


  • Device-doctor financial relationships in spotlight this week: This Friday, inducements to encourage physicians to use medical devices will get attention as a product liability case against J&J’s Ethicon’s transvaginal mesh is heard in a New Jersey federal court. At issue: the role the company played in encouraging physicians who helped write the clinical guidelines for its use by obstetricians.
  • Doc fix passed by House: Friday afternoon, the House of Representatives passed their version of the SGR fix by a vote of 238-181, agreeing to pay doctors .5% more annually for 5 years. The $138 billion cost for the fix would be paid for by delaying the individual mandate in the ACA five years—objectionable to Democrats. The House version will next go to the Democratically-controlled Senate where it faces little chance of passage.
  • Med Mal: The Florida Supreme Court ruled the state’s cap on medical malpractice awards unconstitutional. Florida is one of 35 with caps.

Public health:

  • Drug addiction: 3.5% of US adults, or 6 million, reported using prescription sleeping pills in a one month period from 2009-2010, up from 2% in 1999-2000. 55% of these take other sedating drugs, and 10% 3 or more. (Harvard Medical School study in Sleep, February 2014)
  • Pre-hypertension: 49 million Americans are pre-hypertensive (blood pressure between 120-80 and 139/89) and at risk for strokes (Neurology March 12, 2014)

One Comment

  • Dwight says:

    Good writing! Two questions:
    1. I am having difficulty connecting the dots between the Pew Report and Taylor’s book and your interpretations for health care in your post, e.g."they want ownership of their medical record", "treatments that are necessary and understood", and more. Were there questions asked about healthcare in the Pew study? Are you drawing on other data about Millennials and healthcare? Or are you extrapolating from the data to healthcare?
    2. Is it possible that the differences between the generations is just about aging? For example, will Millennials think more like the baby boomers when they age 30 years? Will their present perspectives and beliefs endure? For example, will they always have relatively less trust in institutions? From a methodological point of view, it would be best to test each generation at the same age to sort this out.