Thursday, November 18, 2010

How Things Stand Now With the Politics of Health Reform: A Summary from the New England Journal

Maybe the Disease Management Care Blog is reading too much of the New England Journal, but it liked Dr. Oberlander’s analysis of the morbid politics of health reform. This is a good update of how things stand and what to watch for in the coming months.

To wit:

The resurgent Republicans' seem to have a threefold battle plan:

1) Symbolism with hopeless attempts to repeal Obamacare, having noisy hearings and forcing votes that embarrass their political opponents, all designed to cater to a political base,

2) Pointed attacks, using their majority in the House of Representatives to fiscally castrate the more unpalatable components of the law, such as the Independent Payment Advisory Board or "the mandate" by refusing the necessary appropriations. While not mentioned in the article, the DMCB also wonders if the Republicans will get in the "weeds" and make mischief in the wording of the enabling reglations behind the ACA.

3) Seeking political advantage by building on the political momentum of the 2010 elections by forcing their Democratic opponents – including the President – to "resell" the Affordable Care Act (ACA) in 2012. Not only will they have to champion a law that is unpopular among many voters, but they will have to deal with its “identity crisis.” In other words, the ACA, which is a complex amalgam of consecutive programs, new subsidies and complex regulations, has failed to achieve a single “story” or recognizable brand. This is not like the "Civil Rights" legislation of the 1960's.

What is high stake politics, however, without some risk? Parts of the ACA are popular (coverage of children through age 26 and no lifetime limits, for example) and it’s not like the Republicans have any easy answers of their own that control costs, maintain insurance coverage and doesn’t add to the deficit. It remains to be seen how they will deal with this.

Two additional wild cards are 1) the States, many of which may resist going along with the health reform law and 2) the Courts’ rulings on the Constitutionality of the law. Both seem to favor the Republicans, because even if the States are forced to cooperate and the law is ultimately ruled constitutional, the drawn out political and legal wrangling may prompt voters to doubt the law’s legitimacy.

Right now, this political tide favors the Republicans. The turbulence favors bloggers. Stay tuned.

1 comment:

Phil 314 said...

The linked editorial was not very good:
1) effectively de-insure 32 million Since the majority of the uninsured have not yet experienced the full force of the PPACA many do not yet have insurance so this statement is inaccurate
2) raise the deficit Surely the author appreciates the data and viewpoints that suggest that the PPACA will increase the deficit.

As long as the debate around PPACA, revisions to it and alternatives to it, is strictly partisan we won't be able to ask ourselves the hard questions (i.e. does the elimination of pre-existing conditions without a mandate and strong penalty lead to significant cost increases )that could lead to a financially sustainable and acceptable health care reform that significantly improves access.

Personally, I don't believe repeal is possible but lots of discussion/debate and maybe some positive revisions will be in our foreseeable future.