Sunday, July 27, 2008

The Housing and Economic Recovery Act Teaches the DMCB What It Will Take to Achieve Healthcare Reform

When the Disease Management Care Blog watched the closing U.S. Senate debate on the Housing and Economic Recovery Act, it wondered if advocates for federal healthcare reform aren’t lusting for the same Congressional bipartisanship and alacrity. While all political hands were on deck for the mortgage crisis, healthcare languishes. How so?

While not having the information and experience of the insightful denizens of Healthpolicyland, the DMCB drew some lessons from watching C-Span’s broadcast of Senator Dodd’s speech on the Act. It gave good insight into what it takes for him and his colleagues to come into work on a summer Saturday morning:

Follow the money: when both Wall Street and Main Street are economically threatened by a pressing crisis, Government acts.

Implications for healthcare reform: while both Wall and Main Street don’t like it, the price of health care is still a burden, not a crisis. It’s also relatively slow moving, versus the nightly news spectacle of overnight bankruptcies and waves of foreclosures. It’s unclear what it will take to turn the health care burden into a threat.

Follow the voter: middle class persons and retirees, making up the bulk of registered voters, were not only watching their real estate values decline, but the contagion was hitting their 401Ks. They were not happy 100 days before the November elections.

Implications for healthcare reform: until the middle class and retirees really care about all those uninsured, they’ll have trouble remembering just how many million there are, let alone what to do about it. Sure, they know health insurance is expensive, but so is everything else. Next.

Everyone wins: Wall Street gets federal guarantees while distressed homeowners get a chance to refinance. The aura of government involvement is intended to inject confidence back into the markets, stopping the slide in real estate and equities. The politicians can claim there was action, even if things continue to slide.

Implications for healthcare reform: what proposal promises premium relief for business, a margin for insurers, choice for consumers, buy-in from the physicians, viability for the hospitals, cover for the politicians and breathing room for pharma?

No big money: as the DMCB understands it, Block Grants provide some requisite pork, but it appears the Federales have little appetite for big-bang spending. Instead, they like increased Government oversight, regulation and bureaucracy.

Implications for healthcare reform: does anyone seriously think the U.S. Congress has the stomach to pass a large spending bill?

The DMCB was also struck by the decline in rhetoric over who to blame in the week leading up to passage of the Act - such as lobbyists, big mortgage lenders, housing speculators and unwise consumers. The DMCB will use this as a prognostic sign in the coming health care debates. If the volume over ‘special interest lobbyists,’ ‘greedy insurers’ or ‘evil pharma’ is high, serious reform is probably far away.

Consider this cold dose of reality from Victor Fuchs this Health Affairs piece. Using his logic, mortgage reform benefited from the three-fold alignment of special interests, the pain of continued inertia and increasing unity. In contrast, healthcare reform is still currently batting zero out of three. The election of a new President and the creation of a Senate supermajority In November are unlikely to change that.

Toss in preoccupation with the economy, the environment, Iran, Iraq and Afghanistan. Mix thoroughly, place in a pan, bake in a pre-warmed oven at 350° and decide for yourself how likely health care reform is in the short term.


In a prior post, the DMCB mentioned 'The Black Swan.' This is an extremely interesting book about the underappreciated role of remotely possible and unforeseen events in a world that operates as if everything can be arrayed around a mean with a standard deviation. 'The Black Knight,' the very successful ‘Batman’ movie not only possesses eye candy and displays the late Heath Ledger’s considerable acting skills. It also showcases the contrast between the coin-flipping reliance on choosing between two known alternatives (by Two-Face, a former district attorney from Mediocrestan) and the catastrophes possible when the unmanageable unforeseen happen (thanks to the Joker, who was raised in a dysfunctional household in Extremestan). To top things off, there is even a display of the Prisoners’ Dilemma.

Definitely worth seeing.

No comments: