Dog Whistle Politics and the Repeal of the ACA: The Endgame is the Privatization of Medicare?

Emboldened by the further erosion of pubic support for health reform, it seems opponents have become more brazen in their plans to repeal the Affordable Care Act. As the politically naive Disease Management Care Blog understands it, they're planning a two step roll-back. Step 1 is to take control of Congress at the midterm, followed by Step 2, when Mr. Obama is replaced in 2012 with a politician sympathetic to their cause. In the meantime, the DMCB expects the opposition to pursue a scorched earth policy and do everything it can to hobble the ACA. This includes defunding the bill, meddling in the formulation of regulations (if the Dems can do this, so will the Republicans) and relegislating parts of the bill.

The DMCB says watching this partisan overreach unfold is for amateurs. The keen-eyed DMCB will instead be tracking a fundamental endgame far more pernicious than simply strangling the ACA in its crib. The DMCB will be on the look out for the re-runs of Republican mischief such as cancellation of the Department of Education, tax cuts for gazillionnaires, the OK of caribou-killing Alaskan oil drilling, the OK of flounder-killing Gulf drilling and, worst of all, the privatization of Medicare.

As a physician, the DMCB has learned use symptoms to look out for disease. When it comes to health reform, the class of symptoms the DMCB will use to monitor the disease of privatization will be dog whistle politics. It's defined as the use of otherwise innocuous terms that have an important meaning for an political-insider knowledgeable base (a good example is here).

In the coming weeks and months, the DMCB scouring press conferences, speeches, press releases and position papers that use dog whistle terms like "high risk pools," "reinsurance," "individual health savings accounts" and "patient choice." Come to think of it, the DMCB will also examine closely examine any statement that includes "The American People," "common sense," "listening," and "restore Medicare."

Be afraid. Be very afraid.