Into The Health Reform Swamp: 2010 to 2014

With a month to go before the November 2 elections, The U.S. is headed into a health reform swamp already teeming with uncertainties. The U.S. economy is mired in uncertainty, and health reform is in limbo. As I enter the swamp, I will hike high my hip boots as I wade in to consider these five factors.

1. The lack of a U.S. budget - Congress left for pre-election recess without passing a budget. Consequently, Americans have no idea what to expect next year. We do not know what our taxes or our health care expenses will be. That makes it hard to plan for the future. This is bad for families. It is even worse for business. Business cannot decide on payroll, capital expenditures, the cost impact of health reform or anything else because it does not know what moves will be profitable or even what their costs will be.

2. The November elections themselves - According to today’s New York Times, the outcome is uncertain. The title of the Times article speaks for itself, “House Majority Still Uncertain, Republicans Say. Races Grow Uncertain. G.O.P. Strategists Can Count on Only Half the Seats Needed.” This may be wishful thinking on the part of the Times, since national polls average indicate otherwise. Nevertheless, it creates uncertainty. As one observer said of the current national malaise, “It’s the Uncertainty, Stupid!” This uncertainty is particularly prevalent in health reform, as citizens and businesses try to sort out what the new law means for them.

3. What Republicans if elected as the majority will do about health reform - As part of their Pledge to America, Republicans vow to defund, repeal, and replace Obamacare. Defund they can, but they cannot repeal and replace the reform law. The GOP could not override an inevitable Obama veto. What they can do is stall or even reverse certain provisions – like implementing health exchanges in the 50 states. One thing seems certain. They will not try to reverse popular reforms already in place – such as coverage for those with pre-existing illness of coverage of young adults up to age 26 under their parents' plans. Much will depend on Obama’s appetite for compromise if his political opponents have a majority.

4. Loss of current health plans coverage by those now insured - It is uncertain how many Americans will lose employer-based insurance before 2014. Various reports estimate between 50 million and 100 million will lose their present coverage and will be either dropped by employers or be forced into higher priced government plans. A report by Tom Coburn MD (R.Okla) and John Barassmo (R.Wyo) puts the number even higher, at 150 million ( Bad Medicine: A Check-up on the New Federal Health Reform, July 2010). Here one must consider the source – Republican doctors who double as national politicians.

5. The political impact of the doctor shortage - Here I shall simply quote a September 30 Reuter’s article on the worsening doctor shortage,” The Association of American Medical Colleges released new estimates that showed shortages would be 50 percent worse in 2015 than forecast. While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025. The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare.The AAMC projected a shortage of 33,100 physicians in specialties such as cardiology, oncology and emergency medicine in 2015.” I believe the physician shortage could precipitate a political crisis. What good is coverage without physician access?

Conclusions

The health reform swamp’s turbulence and turbidity will increase between 2010 and 2014 as political majorities shift, premium costs mount, the insured lose coverage, and the physician shortage intensifies. Whether Obama emerges unscathed aund unmuddied from the swamp will depend on the health of the economy and how Americans react politically to the offsets between to costs of covering 32 million more citizens versus loss and increases in personal costs with benefit declines of current plans.