OP-ED

The Road to Repeal?

Emboldened by their victory in the Midterms, many Republicans are calling for repeal of the Patient Protection and  Affordable Care Act (PPACA). How likely is it that we’ll see changes any time soon?  Probably not very.  More cautious observers are expressing reservations about the prospect of any reversal in the near term.

Paul Ryan, R-Wisconsin, one of the Republican young guns, says, “You can’t fully replace this law until you have a new President and a better Senate. And that’s probably 2013, but that’s before the law fully kicks in on 2014.”

Michael Tanner, a senior fellow at the conservative Cato Institute, is more straightforward,”Repealing Obama care is just not going to happen while Obama is in office.”

In the meantime, expect the following events to play out over the next two years.

1. House Republicans will vote overwhelmingly to repeal Obama care, with modest Democratic support from those elected who opposed Obamacare.

2. Harry Reid, Senate Democratic leader, will refuse to bring the House repeal up for a Senate vote.

3. President Obama will insist, as he already has, that it is foolish to “relitigate” a law which he regards as set in legislative, historic, and ideological concrete.

4. They will call upon Kathleen Sibelius, Secretary of Health and Human Services, to explain why costs have risen sharply since passage and why so many insurers and businesses have dropped coverage.

5. They will summon Doctor Donald Berwick, Administrator for the Centers of Medicare and Medicaid Services, to explain his views and to justify why he should be reseated following his recess appointment.

6. They will seek to repeal the reform the provision calling for submitting of 1099 forms for every $600 of business expenditures – a possible item of compromise.

7. They will seek to repeal restraints on Flexible Savings Accounts and Health Savings Accounts.

8. They will try to defund the $10 billion required for hiring 13,500 IRS agents to enforce individual mandates and track those who are qualified to receive federal subsidies.

9. They will try to defund the $10 billion needed to carry out other mandates, such as state based health exchanges, and regulations calling for more expensive comprehensive one-size-fits-all
policies meeting federal standards.

10. They will discuss extending more waivers, such as the ones already granted to McDonalds and similar companies, who say they cannot afford Obamacare mandates.

11. They will push to expand and replace the existing $50 million demonstration projects scheduled for malpractice reform.

12. They will introduce their own incremental reform issues – shopping across state lines, offering tax deductions to those with individual coverage, malpractice reform, expanded health savings accounts.

These dozen things will serve as fodder for the 2012 Presidential election.

One party’s meat – victorious Republicans calling for incremental or total repeal – will be the other party’s poison – defeated Democrats defending popular aspects of the law and praying defenders will not be ousted as most were in 2010. Both positions will require skill, luck, and a favorable political climate to carry out.

The big question is: are Republicans repeating Obama’s mistake by concentrating on health care rather than the economy?

Richard L. Reece, MD, of Old Saybrook, Connecticut, blogs at Medinnovation and is author of two recent books, Obama, Doctors, and Health Reform and Innovation-Driven Health Care. He works closely with The Physicians Foundation, a 501-C3 organization representing 700,000 physicians in state medical societies that issues grants to physician organizations to improve care. He can be reached at rreece1500@aol.com or 860-395-1501.

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24 replies »

  1. Good points. Once government has its ‘hooks’ into launching such programs, it is very difficult to reverse directions. As the inventor making possible the modern Automatic Heart External Defibrillator (AED) unlike most Americans I have been the guest to many nations who have these kind of programs. Almost universally I would say that many of their best physicians have left such countries for the U.S. Citizens are brought to think they have ‘free’ healthcare even though they are paying 50-80% income taxes.

  2. What about the billions that will be spent (mostly offshore) to have DX and procedure codes added to EOBs and adverse benefit determinations available in still ill defined “culturally and linguistically appropriate manner”. This is essentially a tax that will be paid to Chinese and Indian software development firms. The insurance industry is already scrambling to try and implement by July and spending money hand over fist to get it done. That money will need to be tacked on to premiums, why, so we can send snail mail your personal health data in almost unreadable fashion (for the average person) in any language on earth. Oh and yes they are currently defining a $10 set fee office copay an adverse benefit determination!
    This is what happens when you need to buy votes from special interest to pass legislation.

  3. Arguments against the individual mandate remind me of similar arguments against mandatory safety helmets for motorcycle riders.
    Until this year, thanks to the political influence of rural representatives, here in Georgia pickup trucks were exempt from the seatbelt law.

  4. Socialized Medicine
    J.S.
    It’s about access not quality. Danny Williams was triaged and didn’t like to know he was just a regular guy. Someone ahead of him was more in need. The rich can do whatever they like. The bill is for everyone to get the best care possible, no one stops the wealthy to buy additional insurance to go out of pocket. In the UK, you can buy additional health insurance at the grocery store and have a better chance of getting a doctor ahead of someone else.
    The bottom line: if I get cancer in the United States, I not only may lose my life but my house as well. If I get cancer overseas, my family can still have a roof over their heads.

  5. DANNY WILLIAMS
    ” .. I’d like to suggest that a majority of Canadian cardiologists, including my father, three cousins and a nephew — stay in Canada ..”
    Tell that to Danny Williams. The Canadian provincial premier who flew to NYC for heart surgery, instead of staying in Canada.
    Socialized medicine — low-quality.

  6. Tired of the ranting comments and Dr. Heath — I’d like to suggest that a majority of Canadian cardiologists, including my father, three cousins and a nephew — stay in Canada. Describing your neighbouring country’s system as corrupt and a disaster is professionally and socially irresponsible and I would expect better of a physican. Glad, sir, that you aren’t my doctor, since veracity and valid research aren’t a typical part of rhetorical skills at least.

  7. “FREE MEDICAL CARE?”
    “Free” got us Fannie/Freddie, Bwarney Fwrank, Chris “CountryWide Mortgage,” OweBama golfing more than GWB, $12,200,000,000,000 in public debt, Medicare/Medicaid/SocSec being BANKRUPT.
    Yeah, free — and LOUSY quality.
    See you in court, Perfesser OWEbama.

  8. “Hey Alex, do you like be told what you have to buy if you don’t want it?”
    People don’t like being told to wear seat belts, motorcycle helmuts, buy car insurance, keep the speed limit, get a food license, pay for parking, install pollution controls, pay property taxes, pay income taxes, but all of this protects the general public from paying for the results of not doing those things.

  9. When and if the docs elect to not take on any new Medicaid and Medicare patients, the best laid plans of ObamaCare will fold.
    Since half the docs and nurses, etc. are “boomers” and seniors, they will have more incentive to retire or semi-retire as part time work for them on an “as needed” basis will be plentiful. How many pre-med students will look at med school with a positive outlook when income will be determined by federal and state legislatures, as will as some process to exclude them for becoming specialists?
    Don’t worry; be happy, as this monster will be self destructing.

  10. Arguments against the individual mandate remind me of similar arguments against mandatory safety helmets for motorcycle riders.
    Until this year, thanks to the political influence of rural representatives, here in Georgia pickup trucks were exempt from the seatbelt law.
    Similar outrage was aimed at the public accommodations section of the Civil Rights Act of 1964. The very notion that the government could infringe on the right of privately owned restaurants to serve or refuse service to anyone they chose was seen as the first steps on a slippery slope to tyranny.
    Getting humans to do the right thing is like herding cats. And we can always depend on some alpha cat or two to lead the resistance.

  11. “You can’t fully replace this law until you have a new President and a better Senate. And that’s probably 2013, but that’s before the law fully kicks in on 2014.”
    BOTTOM LINE:
    Harry Reid, Senate Democratic leader, will refuse to bring the House repeal up for a Senate vote.

  12. Hmmm, there is invested, and then there is enslaved.
    Hey Alex, do you like be told what you have to buy if you don’t want it?
    If you say yes, you are either a liar or clueless!

  13. I think the other major question is why should the law be repealed. Coverage for everyone is the first step to improvement. We can’t fix a national problem (i.e. health) if everyone is not invested.
    Alex

  14. “”In my also most 40 years working in Emergency Departments though-out this nation, and many others, I have never seen anyone turned away in this country, not once.””
    I have, even though I have only 37 years. But, it is rare now. The bigger problem is follow up care. It is there that the system really lacks, not in emergency care.
    “Almost universally I would say that many of their best physicians have left such countries for the U.S.”
    That is odd. I know of no data to support that assertion. I cover at three different hospitals and maintain relations with my training facilities. No European, Japanese, Australian or New Zealand docs. I do see Eastern Europeans, Indian and Pakistani physicians. Guess things are different where you work.
    “11. They will push to expand and replace the existing $50 million demonstration projects scheduled for malpractice reform.”
    Nope. When have Republicans ever made a serious attempt at malpractice reform. After contributing lots of money and meeting with Republican office holders on this issue, I have concluded that they do not care.
    Steve

  15. Already, we have 1.175 employees at 111 unions, firms, and plans exempt from section 2711:
    http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html
    Politically connected entities are slipping and sliding away from PHS requirements, which means that firms without allies in DC are going to be subject to the requirements. That essentially means that bureaucrats at HHS decide who stays in business and who dosen’t.
    This is going to be a job killer of epic proportions.

  16. http://www.washingtonpost.com/wp-dyn/content/article/2010/11/12/AR2010111202811.html?hpid=sec-health
    Hmmm, whatta ya think, colleagues, just the beginning of more disruptions in care than not?
    And why does the AMA keep getting press for negotiating for the 20% of physicians in this lame ass organization? And who are these 20% of less than intelligent colleagues who still belong?
    Makes you wonder if random chance is really 5% these days in examples like this

  17. As a provider (and direct benefactor) Dr. Reece I see why you think the status quo for healthcare works just fine, but what about the people who pay for care, what would you replace the present law with to stop unsustainable cost increases that are expected to top 20% GDP?
    “4. They will call upon Kathleen Sibelius, Secretary of Health and Human Services, to explain why costs have risen sharply since passage and why so many insurers and businesses have dropped coverage.”
    Maybe because it isn’t as easy to offload costs to the uninsured and under-insured. You see when you have to start paying for the true cost then rising prices becomes an issue.

  18. “In my also most 40 years working in Emergency Departments though-out this nation, and many others, I have never seen anyone turned away in this country, not once.”
    It’s not about the turning away, it’s the paying for. But, outside of an emergency do you think anyone is turned away/kept away from care because they can’t afford it?

  19. As a provider (and direct benefactor) Dr. Reece I see why you think the status quo for healthcare works just fine, but what about the people who pay for care, what would you replace the present law with to stop unsustainable cost increases that are expected to top 20% GDP?
    “4. They will call upon Kathleen Sibelius, Secretary of Health and Human Services, to explain why costs have risen sharply since passage and why so many insurers and businesses have dropped coverage.”
    Maybe because it isn’t as easy to offload costs to the uninsured and under-insured. You see when you have to start paying for the true cost then rising prices becomes an issue.

  20. LET 1,000 CUTS BEGIN
    OweBama doesn’t want to “re-litigate?” A law school adjunct doesn’t want litigation? How laughable.
    MESS-iah, your 2,700 page Franken-bill HAS to be fixed. It is KILLING JOBS. Duh.
    See you in court, perfessor.

  21. Good points. Once government has its ‘hooks’ into launching such programs, it is very difficult to reverse directions. As the inventor making possible the modern Automatic Heart External Defibrillator (AED) unlike most Americans I have been the guest to many nations who have these kind of programs. Almost universally I would say that many of their best physicians have left such countries for the U.S. Citizens are brought to think they have ‘free’ healthcare even though they are paying 50-80% income taxes. The inefficiencies of most government programs, plus the corruption they attract, make the majority these programs a disaster. Many in the medical communities in countries want to somehow get out of this quandary, but don’t know how. If action is not decisive here, we will end up in the same boat. Few realize that medical device companies are taxed in the new law as well. This is already reversing progress that would otherwise be made. To one, like me, who has ‘been in the trenches’ in other countries who have enacted such laws, the fact the U.S. Congress and the current Administration has force fed this law upon us it very very disturbing indeed. To think that the American system is somehow inferior to these systems is a fallacy. In my also most 40 years working in Emergency Departments though-out this nation, and many others, I have never seen anyone turned away in this country, not once. All I have seen is a very compassionate nation doing an unprecedented job of taking care of its own. I hope we can back out of this before it is too late. I do think reform bringing more competition is the answer.
    Roger Heath

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