Health Reform Law: A Work in Progress, A Work in Distress

All progress has resulted from people who took unpopular positions.

Adlai Stevenson (1900-1965), Speech, March 22, 1954

Economic distress will teach men, if anything can, that realities are less dangerous than fancies, and that fact-finding is more effective than fault-finding.

Carl Becker, PhD (1873-1945), American historian, Progress and Power (1945)

February 4, 2012 - That the Health Reform law, enacted nearly 2 years ago, is unpopular is indisputable. That it is a work in progress cannot be doubted. That it is a work in political distress is evident from public polls and from GOP vows to repeal and replace it, should they assume power. That to its advocates it represents progress and is well underway should be clearly understood and outlined.

In its winter 2011 edition, Prescriptions for Excellence in Health Care, David Nash, MD, MBA, its editor-in-chief and dean of the Jefferson School of Population Health, outlines this progress in implementing the law in 2010.

Work in Progress- 2010

• Increased mandatory reporting of administrative data

• Continued coverage of adult children up to 26 under parents’ policies

• Strict limits on reasons for discontinuing coverage

• Free preventive screening services for adults
A ruling that non-profit insurers must maintain a medical loss ratio of 85% or higher

• Tax credits for small businesses with 25 or less employees

Work in Progress - 2011

In January 2011, these benefits kicked in.

• Free preventive care

• 50% discount on cost of brand name drugs for seniors falling into the donut hole

• Grants to develop programs to delay onset and reduce prevalence of chronic conditions

• Cessation of payments to hospitals for Medicaid patients who acquire certain infections in the hospital

So Much for Progress, Now for Distress

So much for specifics of progress, now for a few generalities about distress.

Among progressives, the various progressive actions, activated and implemented under federal guidance, are, or ought to be, thought of as wondrous actions of compassion, as acts carried out for humanitarian reasons to protect the public’s general health and welfare.

However and Moreover

However and moreover, among other Americans, these actions are cast in a more regressive light - as acts designed to strip them of their freedoms and latitudes of choice and to impose taxes, fines, and penalties on all in one way or another by an oppressive, centralized, command-and-control government.

Why these interpretative differences?

• First, federal actions to date impact a relatively small number of Americans, perhaps 5 million or so, a tiny fraction of 310 million. Most are college students covered under their parents’ plan, a few hundred thousand seniors dropping into the donut hole, and even smaller numbers with pre-existing illnesses threatened of being dropped from coverage.

• Second, America is basically a center-right nation. It deeply distrusts federal power, especially when accompanied by an expanding bureaucracy, soaring deficits, and disruption of the status quo. The devil they know, an overly costly health system, is perceived as worse than the devil they don’t know, a looming, overreaching, gargantuan governmental monstrosity.

• Third, among seniors, there is the uneasy feeling that no good can come from a health law that cuts $575 billion out of Medicare over the next 10 years, or beyond that, a future law that may put Medicare recipients on vouchers or premium supports. Medicare, as they know it, they think will never be the same. They are right. The present Medicare system is a speeding train headed over the bankruptcy cliff, and something has to change.

• Four, among doctors, their clinical judgments and their economic motives questioned and pilloried, a general Orwellian feeling persists that the health law, with its myriads of regulations, electronic methods of surveillance, and arbitrary and capricious income cuts, is nothing more than Big Brother in disguise. Consequently, private practice is in sharp decline, morale is low, physician shortages loom, and draconian cuts in income are on the horizon.


• Five, there is a pervasive air of economic and clinical uncertainty among all of the citizenry – federal and state government unions, employers, entitlement recipients, members of the medical and hospital establishment, the unemployed, the employed, the soon-to-be retired, and seniors. This is understandable. Government has a poor track record of containing costs, health law programs to date to change things for the better are untested and unproven, and the decisions of the Supreme Court in June and the voters in November, are unknown and unknowable.

Tweet: The health law, now 2 years old, is a work in progress and a work in distress. Where the reform Merry-Go-Round goes and stops no one knows.