Thursday, May 24, 2012

The Great Scramble if Health Reform Law Is Struck Down
There is no provision in the great scramble and the big divide.
William Graham Sumner (1840-1910), The Forgotten Man (1883), the first professor of sociology at Yale

May 24, 2012 -  What will transpire if the Supreme Court strikes down the Affordable Care Act? 
Who knows? Right now both sides are positioning themselves for the Great Scramble.
·       The Democrats are putting on a brave face.  They are saying the new law is already transforming how care is delivered and some changes will continue (Robert Pear, “Gains in Health System Seen As Lasting by Some,” New York Times,  May 22, 2012).   This is the view presented by Senator Sheldon Whitehouse of Rhode Island and Dr. Richard Gilfallen, director of the federal center for Medicare and Medicaid Innovation.  I agree with this point of view, but it is not at all clear what changes will prevail and how deeply they will affect the system.  Most likely to continue are coverage for preexisting illness and young adults under their parents’ policies, and perhaps the push for bundled billing by hospitals and doctors.

·       Moderate Republicans are talking of keeping the laws’ more popular features while dissing and modifying others (Louise Radnefiske, Naftail  Bendred, Sara Murray, “GOP Mixed Health Moves,” Wall Street Journal, May 22, 2012).   Joe Heck (R-Nevada) calls this the "Repeal, Repair, and Replace"movement.  Some, like Senator Orrin Hatch of Utah, are targeting the excise tax on the medical device industry,  a growing industry in many states.  Still others are advocating striking the old law down and starting anew.  

My own view? 

A complete strike down will not occur. The health system will never be the same again.   Certain popular features will be retained,  and the decline of private practices, consolidation of hospitals and doctors into larger entities, bundled billing, and push for evidence-based outcomes will continue.

     As Paul Keckley, executive director of of Deloitte Center HealtH Solutions,  observes, " Regardless of what happens to the law, the market will force the system to become more efficient"  (Reed Abelson,  "New Fervor to Cutting Costs Among Hospitals and Insurers, " New York Times, Mayy 24, 2012).
So much for my prose preamble.
Now let’s take a poetic ramble,
Among the reform law bramble.
Let’s watch politicians scramble,

And see if markets can unscramble.
The gigantic Obamacare gamble.
Or if they will leave it in a shamble.
Tweet: Even if Supreme Court strikes down health law, certain changes will continue. It may soon be  gone but it will not be forgotten.

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