Sunday, December 12, 2010

2011: Health Reform-Repeal Tipping Point

When considering the outcome of upcoming debate over whether to repeal, replace or retain the Accountable Care Act, it is important to put things in historical context.

2011 will be the tipping point of a debate that has been growing in intensity since the HMO Act passed under Richard Nixon in 1973. In a book I wrote back in 1988, And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (Media Medicus), I described events leading up to this tipping point with these words,

“ I shall discuss the struggle now going on for control of health care. This struggle is mainly between the management of corporations and physicians. It is a struggle for power. To be effective in the marketplace, corporations have to harness physicians to corporate goals, thus creating internal discipline and compliance; to be independent professionals, physicians have to be free to choose what they want for patients. The government, economists, and leaders of large organizations favor the corporate strategy because it is a way of making physicians behave economically.”

My fear then, as now, was that the corporate and government strategies would alienate physicians, harm their job satisfaction, make their economic situation untenable, discourage bright young people from entering the profession, create a physician shortage, and precipitate an access crisis.

Sad to say, these events are now unfolding. Since 1970, managed care corporations and government health care forces have steadily grown in power. United Health Care, started in Minnesota, now proclaims in its ads that it employs 78,000 people caring for 78 million Americans. The federal government in 1970 provided 35% of funds for personal health expenditures in the United States; that number is now approaching 50% and promises to grow even greater under the Accountable Care Act. We have reached the tipping point.

Perhaps I should say “flash point” rather than” tipping point.”

In its lead editorial today, AOL asks,”What’s the No. 1 issue for GOP in 2011?” It answers, “Forget tax cuts, gays in the military and even immigration. The hot-button issue for newly ascendant Republicans will be the health care law.”

The outcome may hinge on how the Supreme Court rules on the constitutionality of the individual mandate. Other issues will be costs, tax reporting requirements, and health insurance exchanges.

On a deeper philosophical level, the debate will be about government unleashing and refining managed care techniques to harness and harass doctors versus the virtues and faults of free market health care. It will be a struggle for power between corporate managers, government bureaucrats, and physicians. It will also be a struggle for freedom for patients and their physicians.

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