Wednesday, January 19, 2011

Four Will-O’-the -Wisps of the Health Reform Debate

Today debate begins in earnest on whether to repeal the health reform law, which brings up the subject of "will-o'-the-wisp."

A will-o’-the wisp is a phosphorescent light sometimes seen at night over swampy ground, caused by spontaneous combustion of gases giving off by rotting organic matter. Will-o'-the-wisp is also a false, elusive, and misleading hope or question.

Will-o’-the – wisp is an apt metaphor for the 4 central questions that will dominate the health reform debate for the next two years.

Here is how the New York Times articulates these will-0’-the wisp questions.

“Will the health care law, approved last year by Democrats with no Republican support, increase or reduce future federal deficits? “

“Will the law lead to the elimination of jobs by overburdened employers as Republicans assert, or will it create jobs as Democrats maintain? “

“Will the law raise or lower the cost of medical care for individuals and families, employers, and state and federal governments?”

“And, will the law achieve President Obama’s goal of providing coverage to more than 30 million uninsured Americans? “

Answers to these questions lie in the future and are unanswerable at present. The answers depend on financial and ideological assumptions untested by reality. One can take the same set of data arrive at totally different conclusions, and no one can challenge you because nothing has happened yet.

Take the question of federal deficits.

The Congressional Budget Office says repealing the Affordable Care Act would increase the deficit by $230 billion over the coming decade and by a modest amount in the decade after that.(1) The CBO estimate has become the central defense by ACA advocates fighting the upcoming repeal vote in the House. Democrats also maintain the cost of adding 32 million people to entitlement rolls will be "only" $938 billion through 2019.

But previous CBO officials assert the $938 billion figure is a "fictitious" low-ball estimate, and true costs after ten years of full implementation in 2014 will be "more like $2.3 trillion." (2)

Besides, these past officials add, “The history of federal entitlements is one of inexorable growth. Once erected, more and more people get added to the programs. The ACA will be no different. Spending will soar, and the tax hikes and spending ‘offsets’ that were cobbled together to get the bill passed will either wither away or vanish altogether.”

And so it goes. So much depends on assumptions, projections, political posturing, and real world events, such as the recovery of the economy and the size of the deficit.

Republicans face the political danger of being perceived as lacking compassion, and Democrats as being unrealistic.

Between them lies a political swamp.

In 2010, voters will decide who won the political arguments, whether the arguments were mainly "gas," and whether the health reform law will,

• restrict choice and freedom

• raise costs for individuals

• increase deficits

• create jobs

• improve care

. aggravate the doctor shortage

• widen access


1. David Herszenhorn and Robert Pear, “Basic Questions, Elusive Answers, “ New York Times, January 18, 2011.

2. Douglas Holtz-Eakin, Joseph Antos, and James Capretta, “Health Care Repeal Won’t Add to the Deficit, “ Wall Street Journal, January 19, 2011

Richard L. Reece, MD, blogs a Medinnovation and has a website under construction. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. He can be reached at

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