Requiem for Health Care
Wed January 20, 2010 2:12 am

Patricia Kilday Hart and I were joint recipients of an e-mail tonight from a friend who lobbies in the health care area. It reinforces the point I made in a previous post, which is that the health care issue may be dead for now, but the problems are not going away. If anything, they are all but certain to get worse. The e-mail follows:

* * * *

Maybe it is just the fact my kids – and by definition I – didn’t get much sleep last night, but I’ve been thinking through the implications of Congress failing to pass health care reform legislation and what it means to Texas. This has clearly taken on a higher level of significance with the Democratic Senate candidate nose diving in Massachusetts.

I’ve always viewed politics as the art of the possible and firmly believe that politics drives health care policy options. Perhaps more importantly, finding a political window of opportunity to affect change is very rare, especially at the federal level.

While some will argue that even if the Democrats lose the magical 60th vote with a loss in Massachusetts, they’ve already developed (or are developing) contingency plans to pass health care reform – pass the bill during certification of the election; if the election is close, call for a recount; invoke reconciliation; allow the House to simply adopt the Senate version. While all of these contingencies may technically “work”, they inevitably create a far greater distrust of the Democratic leadership, which is one of the reasons they are in so much trouble – think Nebraska compromise. There is also no guarantee (and I find it frankly highly unlikely) that either Reid or Pelosi can hold their votes for any of the contingency plans if they lose the Senate seat in Massachusetts. Therefore, absent 60 votes I simply do not think that passage of health care reform is politically achievable.

So, working from the premise that national health care reform fails, here is some macro political/economic fallout we should expect. And for all those that opposed the bill and called for state’s right and a “Texas solution” to health care reform, looks like they got it – read, the dog that just caught the mack truck.

--Suffering from issue fatigue and partisan fighting, systemic health care reform is off the table for the foreseeable future. There will be no political will from either party to try significant reform again until a crisis requires it;

--Health care costs and medical inflation will continue to far outpace general inflation and workers’ earnings;

--Increased health care costs will lead to increased insurance premiums, forcing employers to further shift cost to employees or drop health insurance coverage, altogether thereby driving the rolls of the uninsured higher;

--Health insurers go into an “insurance death spiral” as premiums increase fewer will purchase insurance, the sicker the insurance pool becomes, the higher premiums will go, once again leaving fewer people in the pool;

--Private insurers will implement draconian cost containment strategies and payment reductions to try and slow the growth rate of health care costs. This will force more subspecialty physicians out-of-network, thus increasing costs to individuals and further straining physician-patient relations;

--With flat or decreased income, coupled with increased overhead costs more primary care physicians will seek employed status;

--Due to budget constraints and political payback from both Democrats and Republicans, long-term fix of the Medicare SGR ["sustainable growth rate," a formula, mandated by law, which ties Medicare payments to physicians and other healthcare professionals to changes in the economy and other factors--PB] is not viable. Same political dynamics, in addition to AMA’s decision to accept the 21% cut if there is no permanent solution to Medicare SGR complicates one-year/two-year fix;

--Increased federal emphasis on overutilization and fraud – RACs [regional trauma advisory councils] on steroids;

--States that are already facing severe budget shortfalls will further reduce benefits and payment for Medicaid/CHIP services as no increased federal FMAP funding will be available, driving more physicians from the program and further limiting access to care or forcing patients to the ER;

--Decreased physician participation in Medicare/Medicaid and other insurance products empowers nurse practitioners, PAs, retail health clinics and others to fill the void;

--Primary care workforce shortages continue to worsen.

--Dismal prognosis, but that is what you get when you allow bitter, divisive partisan politics to drive health care policy. I hope when the system ultimately careens of the cliff that someone will remember Jim DeMint saying this is our “Waterloo”: kill health care reform, you kill Obama’s domestic political agenda. I dream of the day when politicians start acting like public servants than power hungry, well professional politicians....

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