Happy Anniversary Affordable Care Act

About one year ago, the Disease Management Care Blog was watching health reform unfold in all of its toxic splendor. Deconstructing those complex events will happily occupy pundits, pollsters, editorialists historians and bloggers for years to come. The DMCB likewise hasn't been immune from reflecting on some of the ingredients that were mashed into the dreadful sausage-making that ultimately made up the Affordable Care Act. To wit:

~ an emboldened Democratic Congressional leadership determined to govern from the left of their rank and file;

~ the staking of a U.S. Presidency on a huge roll of the political dice - that could still come up snake eyes;

~ speculative projections from health care economists able and willing to portray any scenario based on assumptions built on theories derived from wishful thinking, which still continues today;

~ organized medicine groups being politically boxed in by a) their prior position statements, b) an bum deal over the SGR and c) fear of being thrown under the bus;

~ the astonishing misuse of 'health insurers" as a political piñata for garnering support, deflecting criticism and changing the subject;

~ equating any lack of support for health reform as a lack of education about health reform.

And how do things stand today? For the best example of how topsy turvy things are, check out the disparate perspectives of some Kaiser report "players and experts."

~ State governments are simultaneously opposing and implementing the ACA;

~ Maybe providers and insurers didn't really need federal legislation to cooperate all along;

~ It's not a majority or any broad political coalitions - which remain stubbornly split - but the small "independent" voter block that may hold the key to the long term survival of national health care reform.

~ The private sector still remains the best hope for innovation.

~ It's in the regulations outside of the legislative process where important battles over the MLR, insurance exchanges, essential benefits packages and worksite wellness programs will be won or lost.

~ The direction of national health reform will be decided by nine lawyers - and probably one in particular.

One question continues to perplex the DMCB: Why is the Administration so reluctant to endorse the eponymous flattery and historical legacy of the term "Obamacare?"

Image from Wikipedia