OP-ED

The Swing to the Right: The Election and Its Effects On Health Reform

Like Tom Friedman, who lampooned some of this year’s unreasonable campaign rhetoric in a recent column, I too would be in favor of reality-based political campaigns … but that seemed to be too much to ask for this year.  Instead of truth, we now have truthiness.  The joke news shows (and their joke political rallies) seemed to be more popular than the evening news.  (I wish Jon Stewart and his 200,000 fans on the Washington Mall last weekend had stayed home, canvassing for their candidates of choice.)  Fact-checkers told us that many political ads this season were in the “barely true” or “pants on fire” zones according to the Truth-O-Meter.  But in the end, the buzzwords seem to have worked their magic, and many “insiders” are out, and “outsiders” are in.  The angry and the impatient on the campaign trail have, in some cases, adopted the line from the movie Network: “I’m mad as hell, and I’m not going to take this any more,” perhaps forgetting that while that line garnered the Howard Beale character strong ratings, network bosses arranged for his on-air assassination when his ratings fell.

The Utopia tune at the top of this post, “Swing to the Right,” comes to you from the Ronald Reagan era, and perhaps we are seeing the generational swing of the pendulum back to the right.  It does seem to happen every 30 years or so … but don’t blame me — I’m from Massachusetts (home to a Democratic sweep this Election Night).

The last two years have seen a tremendous amount of change in Washington.  The question of the moment, of course, is:  How will the election results affect implementation of health care reform?

The short answer is that even having sustained the losses that they have, the Democrats in Congress will be able to sustain a Presidential veto of any GOP anti-health reform initiative.  The 2012 election may well determine the ultimate course of health reform.  If the GOP gains further ground in two years, then implementation may be that much more difficult to accomplish.

For a cogent analysis of the high stakes for health reform in the midterm elections, see Henry Aaron’s recent piece in the New England Journal of Medicine (hat tip: Jane Sarasohn-Kahn, aka @healthythinker).

(As an aside, the challenges to the health insurance mandate pending in courts around the country, of course, also pose a potential threat to health reform implementation.  Interestingly, GOP opposition to the health insurance mandate coexists with support for the spread of affordable health insurance for individuals, even though combining the two positions makes no actuarial sense: without mandate-driven health insurance purchases by Young Invincibles, there can be no “affordable” health insurance for individuals in a community-rated market.)

Stay tuned for the next bit of political theater as the latest “doc fix” expires December 1, and the lame duck Congress decides what to do about the SGR and the nearly 25% Medicare physician fee schedule cut that will go into effect unless, once again, there is some last-minute Congressional action.

Update 11/5/2010: Here’s a better link to the 2007 MedPAC report, “Assessing Alternatives to the Sustainable Growth Rate System,” and a link to the Congressional testimony given on the MedPAC SGR report by Glenn Hackbarth.  It’s remarkable to consider how many elements of MedPAC’s recommendations made their way into the ACA, while the SGR formula was left alone.  As we move forward into the realm of bundled payments and quality incentives (Massachusetts is getting there first), capping FFS inflation is just not where we ought to be focusing our energies.  Here’s hoping that when Don Berwick and Kathleen Sebelius get hauled in to testify at lots of Congressional committee hearings next year they get to put a bug in the ears of the legislators about this issue so that a long-term solution to the SGR issue may be implemented that will be consonant with the way the rest of the health care market is headed.

David Harlow writes at HealthBlawg:: David Harlow’s Health Care Law Blog, a nationally-recognized health care law and policy blog. He is an attorney and lectures extensively on health law topics to attorneys and to health care providers. Prior to entering private practice, he served as Deputy General Counsel of the Massachusetts Department of Public Health.

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Click the “Purge and Replace” check box when you want to replace all of your inventory on amazon login together with the
products within the template. Many manufactured products have bar codes
affixed towards the packaging.

DeterminedMD
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DeterminedMD

MD as Hell, we are a dying breed. It makes you wonder what our colleagues were listening to in medical school. It was either “Ka-ching, Ka-ching”, or “you are here to save the world from itself”. You know what I heard? “You are here to learn a craft that a precious few really have the ability to master and provide to the community you will serve, but make no doubt about it, if you let those who are not your equivalent dictate your work, you will fail not only those you treat, but yourself.” Yeah, we as a profession continue… Read more »

steve
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steve

“Are you this stupid or not an american citizen? The minority party, specially one with as few seats as the Republicans had, can’t even bring a bill to the floor. How exactly does the minority party pass bills?”
I was under the impression that the Republicans held both houses of Congress and the Presidency not long ago. Alas, you are clearly a troll and not interested in real discussion.
Steve

Canadian Pharmacy
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Well i think that this is really nice step or else the health reforms need t be changed from time to time and this is a good time to do reform that is at the time of election.Canadian Pharmacy

Paolo
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Paolo

“Paolo what do you want the minority leadership to do?”
Perhaps, propose reasonable alternatives. Something a few courageous GOP members have done, but the leadership has not. At the very least, don’t poison the well. Some day, the GOP will have full responsibility of governing, and they have made their future life very difficult.
By ranting against any mandates (while being against pre-ex) and rioting against any cut in Medicare (while being against paying for it), the GOP has put itself in a hole. They have created a problem they cannot solve.

MG
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MG

Nate – MG the exit pooling seems to show Seniors are open to reform if they think it will be effective. “Voters over 65 favored Republicans last week by a 21-point margin after flirting with Democrats in the 2006 midterm elections and favoring John McCain by a relatively narrow 8-point margin in 2008.” Yes because the GOP ran an explicit message of restoring Medicare cuts and that Obamacare was ‘taking money from away from seniors.’ There isn’t a single poll I have seen where seniors support Obamacare but it is almost exclusively because the seniors benefits they paid for as… Read more »

Art
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The administration makes a deal with PhRMA to keep drug prices high, a deal with AMA to keep doctors happy and continue increasing reimbursement and the same with hospitals. So cuts are made to Medicare and probably Medicaid shortly while millions more are added each year to both of these entitlement programs. A nice little package except for the fact that we have run out of doctors, nurses and other required health providers, most of whom say they are losing money treating these people and are not going to much longer. Increasing fees won’t solve the burgening problems that not… Read more »

Nate
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Nate

MG the exit pooling seems to show Seniors are open to reform if they think it will be effective. “Voters over 65 favored Republicans last week by a 21-point margin after flirting with Democrats in the 2006 midterm elections and favoring John McCain by a relatively narrow 8-point margin in 2008.” that doesn’t appear to reflect a block of voters with their heels dug in. “When in the last two decades have Democrats had that?” 2008-2010 Peter? “It’s called working across the aisle if you want legislation – something the founders seemed to want and Republicans seem to forget.” You… Read more »

Peter
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Peter

“When was it in the last two decades Republicans had that? Oh that’s right they never did.” When in the last two decades have Democrats had that? Democrats can’t even get their “Bluedogs” to vote as Democrats. It’s called working across the aisle if you want legislation – something the founders seemed to want and Republicans seem to forget. When did meaningful healthcare come up between 1995 and 2005, unless you mean Medicare Part D, which gave millions to drug companies and added to the deficit. For seniors though that was considered fiscally responsible. http://uspolitics.about.com/od/usgovernment/l/bl_party_division_2.htm As I said I’m going… Read more »

stane
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I think the health reforms should continue as planned. I agree with steve’s view on this.

Nate
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Nate

“People choose to be poor?” Yes sometimes they do Steve, thats not the point. Have you never heard of Medicaid? We have a program that gives families making 18K or 30K free insurance yet 10-15 million of them can’t be bothered to sign up. What about the 10 million or so making over 50K and those making over 75K that can afford it but choose not to? “hey have not expended one bit of political capital to try to pass these” Are you this stupid or not an american citizen? The minority party, specially one with as few seats as… Read more »

Paolo
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Paolo

Steve is correct. The current GOP leadership is not interested in pushing a plan. They are interested in using health care as a weapon of fear. It works very well in elections, but it doesn’t the help the country, nor does it help conservative positions in the long run. In the past, there have been a number of Republican comprehensive plans on how to provide health care to all. Not only did Ryan propose a plan, but Judd Gregg had a plan, Bennett had a plan, and so did McCain(version ’08) and Romney(version ’06). I’m not a fan of most… Read more »

steve
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steve

“We have a mandate now, if you don’t buy insurance and get sick you could possibly be denied some care and be financially broke. 40 million people have chosen to ignore this mandate and taken the risk.” People choose to be poor? Given the current costs of health insurance, how is the 18k a year, even the 30k a year family supposed to pay for insurance? “Republicans have a list of reforms they want to pass that would actually make insurance more affordable, improve care, and resolve the problems in the system, ” hey have not expended one bit of… Read more »

Samuel Stenes, MD
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Samuel Stenes, MD

http://www.sltrib.com/sltrib/home/50467795-76/health-insurance-utah-child.html.csp?page=1
Health care reform live: Ruthless conduct by Obama’s favorite, Intermountain Health Care, and BCBS. Nothing like a for profit not for profit.

Corpuscle Connie, MD
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Corpuscle Connie, MD

“To hell with your electronic BS. No one needs universal access to your last hemoccult.”
Yup, the American people have been sold a pig in a poke.
This scandal will have epic long lasting repercussions. If it wastes half as much money proportionately as in the UK, Obama will give the presidency to anyone who runs against him, including the foreign policy expert Palin.
He will not have a ghost of a chance of serving a second term.
Wake up POTUS, you were scammed.