The Long Road From March to November

In politics, a month is a lifetime, and 7 months is an eternity. It’s four months from now to late June when the Supreme Court issues its ruling on the health law, and it’s several months until the election.

No one knows what will happen between now and the election. But whatever occurs, it will be a psychological and political time.

Democrats will put on a brave face. They will say it’s not over until it’s over, that the individual mandate was originally a Republican and Romney idea, that the justices will come to their senses, that this is a moral not a constitutional issue.

Republicans will say that the health law is a train wreck, that it was rooted in ego and arrogance of an overly ambitious president, that Democrats poisoned the whole politics process by completely ignoring the other party and the American public, and that the whole idea of individual and Medicaid mandates is toast.

If they are smart, and there is no guarantee of that, the GOP will issue a detailed alternative plan resting on incremental market reforms with proper government oversight.

Inaction “ on Massive Scale

Over the next seven months, we are likely to have “inaction,” if I may borrow a term from the hearings, on a massive scale.

· The states, particularly the 27 who brought the suit to the Supreme Court, will stall or stop implementation of health exchanges.

· The Obama administration will step back and concentrate on campaigning on other issues to divert attention from its failed health reform law.

· The Romney team will focus on economic growth to distract from Romney’s Massachusetts health care legacy.

· American businesses, large and small, may hire at a modestly increased pace but will hold back because of continued uncertainty.

· The Medical Industrial Complex- hospitals, physicians, health plans, drug companies, nursing homes, rehabilitation centers, drug companies, medical device makers, and health IT companies – will continue to prepare for the next millennium, with or without Obamacare.

Trends in Motion Stay in Motion

However, certain trends in motion will stay in motion.

Paramount among these are:

· Decline in private practice

· Migration of physicians into concierge and other direct pay practices outside the province of 3rd parties

· Consolidation of hospitals, physicians, and insurers tino bigger entities to fend off and for leverage to negotiate with government

· Renewed emphasis by employers on health savings accounts, high deductibles, and other cost-lowering strategies.

· Decentralization of the system into smaller units outside the hospital and other non-institutional settings.

· Increased use of telemedicine and technologies to monitor and reach patients in virtual non-face-to face ways.

· Altered behavior patterns by physicians and patients alike, prompted and accelerated by social media and health IT corporations, as the nation seeks more sensible and affordable approaches to health care.

Richard L. Reece is a retired pathologist and the author of The Health Reform Maze: A Blueprint for Physician Practices. He blogs about health reform, medical innovation, and physician practices at medinnovationblog.

1 reply »

  1. Sounds about right to me.

    Someone called into a talk show a while ago saying he had heard that if the Court declares the mandate unconstitutional the Administration might go ahead with all the rest of the provisions anyway. That would allow a couple of years for Congress to take corrective action since that issue is still two or three years out.

    On the face of it that sounds nutty and unlikely. But remember Day One of the argument was dedicated to an ancient law on the books by which the Court knew would make the entire discussion moot until an actual case of non-compliance coupled with a fine came about and made its way up to the Court. If that is the case, nothing would prevent implementation of the law for another three years.

    I’m sure some smart law clerk has already anticipated this and will bring it to the attention of his peers and hence to all nine of their bosses. It’s a fanciful departure from the usual speculation if nothing else.