Health Reform Stakes

I am tied to the stake, and I must stand the course.

Shakespeare, King Lear

The stakes in the evolving health care debate are enormous. The stakes are real, practical, perceived, local, national, economic, and political.

• For Democrats, control of the House, and maybe of the Senate, in 2010 is at stake. The Affordable Care Act is unpopular, and they must decide whether to run for or against it.

• For President Obama, his legacy is at stake. Health reform is his signature issue. He spent 16 months concentrating more on health care than jobs. Health reform may decide his 2012 election.

• For Republicans, outcome of the 2012 Presidential elections is at stake. This will depend on how well the GOP performs in cutting spending from 2010 to 2012, should they take the House.


• For the 50 States, their financial viability is at stake, as they struggle with federal mandate to cover 16 million more Medicaid recipients, already the greatest burden on their budgets.

• For uninsured Americans, now numbering 51 million, their health care coverage, starting in 2014, is at stake.


• For health care agents and brokers, and for small insurance companies selling and brokering policies to individuals and small businesses, their very existence is at stake.

• For businesses, their ability to continue to finance coverage of employees is at stake, as they sort through the financial and bureaucratic requirements imposed by the new health reform law.


• For Americans with existing policies expiring in 2012 and beyond, their ability to hold onto these policies is at stake, for their new policies will have to comply with more comprehensive and expensive federal standards.

• For 11 million Medicare recipients, their Medicare Advantage plans is at stake, for sacrifice of these plans is the most concrete means of financing the Affordable Care Act.


• For 900,000 American physicians, their continued participation in Medicare and Medicaid is at stake, as they ponder a future of lower reimbursements, burdensome regulations, and restriction of clinical freedoms.

• For 5000 American hospitals, particularly public hospitals, their future is at stake, as they struggle to cope with decreased reimbursements, compliance with federal quality and safety standards, and requirements to install and maintain information technology systems.

• For the medical industrial complex – health plans, drug companies, device manufacturers, and others – their traditional ways of doing business, their profitability, and their survival is at stake.

'For the nation as a whole, the future of entitlement programs, the heaviest and fastest growing part of national debt, are at stake. Will the health reform law, as currently proposed, escalate that debt? Will it slow its growth? Will it protect Medicare against bankruptcy? For the moment, no one knows.