Health Care Fatigue and the War Between the States

“This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states.”

Missouri State Senator, Jim Lembke, a Republican, as quoted in “Missouri Voters To Have Say on Health Law,” New York Times, August 1, 2010

I was recently at a physicians’ meeting about how we could make our opinions known and how we might shape the continuing debate on health reform. One participant in the meeting commented,”Health care fatigue has set in. Will health care even be an issue in the November elections?”

I believe it will be.

It boils down to the new War Between the States. The States will bear the financial burden of the law, which shifts 20% of costs of 16 million newly insured to Medicaid to the States. The States, unlike the federal government, must balance their budgets. The new law may break their budgetary banks.

Lest you forget, the health law was the signature issue that elected Senator Scott Brown in Massachusetts. And it may be in other states as well, for health reform exemplifies and magnifies fears of Big Government taking away personal liberties.

Next Tuesday, August 3, Missourians will vote on nullifying the health care law that requires people to pay insurance or pay a penalty. Five other states – Arizona, Georgia, Idaho, Louisiana, and Virginia, has already enacted similar measures, and voters will go to the polls on similar constitutional amendments in Oklahoma and Arizona in November.

Elected officials in 22 states have filed lawsuits challenging the individual mandate. The U.S. Supreme Court may have to resolve all these issues.

According to Rasmussen, who polls only likely voters, 56% support Repeal and Replacement, but only 48% think voters can do much about it, no matter what the outcome of the November 2 midterm elections.

I predict health reform will resurface as a central issue in November. Physicians can play a constructive role in influencing the November election by pointing out its consequences on physicians and patients, positive and negative, of the new law.

No other issue can match the magnitude, complexity, universality, and controversial aspects of the new law. Physicians, more than any other group, know first hand what it entails for patients. So do the states, who must bear the burdens and expenses of its implementation.