Tuesday, December 22, 2009

Health Reform Passage: The End of the Beginning

Now this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.

Winston Churchill, London, 1942

Winston Churchill had a way with words about the future. Little did he know he would be turned out of office in 1946 after being a triumphant war-time president.

This could also be the fate of Obama and the Democrats and their imminent and self-proclaimed health reform bill triumph.

Passage of a health reform bill may be just the end of the beginning. This doesn’t surprise me. I predicted this in my book Obama, Doctors, and Health Reform and in an interview I granted with Dutch TV (see video on right of this blog).

I also predicted President Obama would celebrate its passage, even though it contains only about a third of what he wants.

What I did not predict was the pay-offs (some say bribes, others say compromises) required to secure passage. As one cynic remarked to me,"This bill is like electing the Mafia to clean up the mess."

What we have now is a bill that says it will cover 30 million more people, increase taxes by $400 billion, and slash Medicare by $500 billion. It will also theoretically cut the deficit by $132 billion. I say “theoretically” because Congress has never had the will or the guts to cut spending in entitlement programs.

Instead, we shall probably see patching, compromising, reconciling, backing and filling, and back room dealings as Congress reacts to public outrage. Recent poll averages indicate only 32% of approve of current bills, 66% disapprove of Congress, and 57% say the country is headed in the wrong direction.

Perhaps, the magnitude of the Democrat’s “historic” achievement will sink in and turn these poll numbers around. But perhaps, as was the case with Winston Churchill, the public will suffer from reform fatigue and vote the rascals out of office. And perhaps, a public backlash will occur when the public learns their premiums are going up, they are forced to buy insurance whether they want it or not, taxes begin immediately. benefits will be delayed until 2014, and savings aren’t realized until 2016 or later.

Meanwhile , paradoxes are mounting. Stock prices of private health plans, demonized by Obama and the Democrats, are exploding. From October 27 until December 21, stock prices showed these gains.

• Coventry, up 31.6%

• CIGNA, up 29.1%

• Aetna, up 27.1%

• Wellpoint, up 26.6%

• United Health Group, up 20.5%

• Humana, up 13.6%

Maybe the health plans know something we don't. Who would have thought it? Private profits for the evil-doers are up in the name of the public good.

In the end, health care reform comes down to a series of trade-offs - potentially mediocre government care with shackling of hospitals, doctors, and entrepreneurs, to even the playing field and provide equity; more government oversight, less private innovations; greater coverage with lesser access because of doctor shortages; damned if you do, damned if you don’t; doomed if you do, doomed if you don't; strive for the public good, and you gore someone's private ox; one man's health hope is another man's benefit cut; what's mine is mine, what's yours is negotiable. These trade-offs, and the accompanying cliches contain grains of truth.

What does it all mean? I like the metaphor of Frank Luntz, a Republican pollster, "On health care , we are not on the 1-yard line, be we are on the 20-yard line. It's close enough that Obama can kick a field goal."

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform (IUniverse.com) is available at www.iuniverse and other book websites. For information on speaking fees and arrangements, call 860-395-1501.


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