Saturday, December 3, 2011

Consequences of 2012 Elections on Health Reform

The consequences for Americans will be huge.

David Blumenthal, MD, MPP, “2012- A Watershed Election for Health Care, “ New England Journal of Medicine, December 1. 2011

December 3, 2011 – In the New England Journal of Medicine two days ago, Doctor David Blumenthal, of Harvard Medical School, former Health Information Coordinator for President Obama, speculated on the consequences of three outcomes of the 2012 elections.

OUTCOME #1 – Status quo (Obama reelected, Democratic Senate).

“Continued implementation of ACA coverage and delivery of reform provisions, barring Supreme Court decision to overthrow entire law. Consequences – Reduced rates of uninsured patients in America, aggressive implementation of ACA health reform provisions.”

My comment - I agree with Blumenthal that this is unlikely election outcome. However, I do not think aggressive implementation will succeed. States will go slow because of oppressive Medicare burdens and businesses will be slow to hire because of uncertainties of ACA-imposed expenses. Businesses have already dropped 4.5 million from coverage in anticipation of Obamacare. Furthermore, care access will become political criss as doctor shortage worsens as 48 million more Americans become Medicare eligible from 2011-2014 and as 34 million more enter Medicaid in 2014.

OUTCOME #2 – Obama reelected. Republican House and Senate.

“Even if Supreme Court upholds law in entirety, political stalemate leads to compromise that reduces funding for coverage expansions, slows implementation of health exchanges, and reduces funding for health system reform. Consequences: maintenance of near pre-ACA levels of uninsured Americans; no substantial growth of levels.”

My comment: Reasonable bet that Obama will win and lose Congress. Blumenthal does not mention that private sector will adjust by offering lower cost care in cash-only settings and by reducing # of uninsured through HSA plans (1/3 of those who sign up for HSAs were previously uninsured). He also fails to say problem not exclusively # of uninsured, but dramatic cost increases imposed on the insured.

OUTCOME #3 - Republican government, Republican House and Senate).

“Repeal of coverage provisions of ACA, without replacement. Retention of system-reform provisions that do not require federal expenditures (value-based purchasing, demonstrations of patient-centered homes. Resumption of pre-ACA rates of growth in number of uninsured Americans. Federal health system reform activities that are similar to pre-ACA activities.”)

My comment: Blumenthal neglects to mention that some Republican measures - universal vouchers, shopping across state lines, market competition, malpractice reforms, and Federal Health Benefit –type system for all- may reduce costs and number of uninsured.
Tweet: 2012 elections will be huge event for health reform with consequences, some good some bad, for all Americans, depending on your politics.

Tweet: The 2012 election will be watershed event for health care with huge consequences for every American.

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