With the 2020 elections approaching, public and political support for Medicare for All is surging. While its legislative prospects are unclear, health care leaders need to understand why support for single payer has grown so drastically. The most important reason: the increasing anger and discontent directed at the health care industry due to the unaffordability of care.

As concerns about affordability mount, both public and private payers are actively working to curb health care spending. They’re attacking the issue on many fronts—limiting price growth, managing utilization, and shifting care to lower-cost ambulatory settings. These moves are poised to exacerbate the margin challenges already facing hospitals and health systems today. Future success will require leaders to navigate the tension between the need to grow revenue while also delivering on the market’s demand for affordability.

Read on to learn the top 15 insights that will drive health system success in 2020 and beyond.

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Insight #1: Support for Medicare for All is a symptom of rising public anger over the unaffordability of health care. (p. 4)

Insight #2: Top-down spending controls are becoming more politically palatable on both sides of the aisle. (p. 6)

Insight #3: Payers of all stripes are reaffirming their commitment to physician-led steerage, calling existing hospital-physician relationships into question. (p. 8)

Insight #4: Rather than trying to be all things to all people, primary care disruptors are deploying targeted models that appeal to specific patients, payers, and physicians. (p. 10)

Insight #5: There is insufficient physician supply to support a large-scale embrace of low-panel primary care models—segmentation is the only realistic path forward. (p. 12)

Insight #6: The industry is on the cusp of major advancements in technology that will enable previously unthinkable administrative and clinical economies of scale. (p. 14)

Insight #7: Leaders face an inevitable margin management challenge that requires accelerated strategies for revenue growth as a critical part of the solution. (p. 16)

Insight #8: The major barriers that prevent organizations from achieving necessary levels of revenue growth are internal and structural, but also solvable. (p. 18)

Insight #9: Achieving true systemness is the foundational step to overcoming internal barriers to growth. (p. 20)

Insight #10: Despite rapid expansion of ambulatory access points, physician wait times continue to mount—and providers are leaving lucrative revenue on the table. (p. 22)

Insight #11: Resolving the access challenge will require leaders to confront the hidden wait times that exacerbate delays. (p. 24)

Insight #12: Strategies to achieve sustainable revenue growth and long-term cost control share the same core principles. (p. 26)

Insight #13: The urgency to address the social determinants of health is mounting—but doing so requires a long-term commitment that goes far beyond current efforts. (p. 28)

Insight #14: Every hospital and health system will have to develop innovation capabilities to fully capitalize on new technologies and partnership models. (p. 30)

Insight #15: No one segment of the industry can meet the market’s demands on its own; partnerships will be critical to success. (p. 32)