The Big Health Reform Kabuki Dance

We have piped into you, and you have not danced.

Matthew 11:7

Not to go back is somewhat an advance,

And men must walk, at least before they dance.

Alexander Pope (1688-1744).  An Essay on Man

In common English usage, a kabuki dance, also kabuki playis an activity or drama carried out in real life in a predictable or stylized fashion, reminiscent of the Kabuki style of Japanese stage play.^[It refers to an event that is designed to create the appearance of conflict or of an uncertain outcome, when in fact the actors have worked together to determine the outcome beforehand.

Kabuki Dance, Wikipedia

February 1, 2013 -    My second book in the series, New Voice of Health Reform: The 3 R's - Rhyme, Rhetoric, and Reality,  is  available today.  The title of the second book in the series is The Physicians Foundation- A New Voice for Physicians.  It is a $19.95,  250  page paperback and may be ordered at 1-203-245-3959 or  at rrjulia@ondemandbooks.com.

As I make this announcement,  I am thinking health reform is an elaborate Kabuki dance.  The dancing instructor is the federal government.   The dancing partners include employers, physicians, hospitals, health plans, the 50 states, health care companies,  260 million Americans with health insurance,  and 50 to 60 million uninsured and underinsured. In essence, every American is invited to the Dance and  has a chance to dance.

The problem with this metaphor is that so far, the Big Kabuki Dance has been one step forward, and two steps backward.    There is no going back, but the way forward remains uncertain.  The promises of the Big Dance – lower costs, smaller deficits, preservation of existing insurance, greater access for all, increased efficiency, and improved outcomes – have not been fulfilled. 

It takes two to tango. It takes millions to Kabuki. The majority of the dancing partners remain reluctant to move forward until they receive further and clearer instructions and can determine where the Big Kabuki  Dance is headed  or whether their toes will be stepped upon.

The instructor, to  help the Big Kabuki Dance advance,   has elimiated certain dance steps– the CLASS act for long-term care,  1099 forms for businesses;  modified other steps – the contraceptive mandate, 1700 waivers for small businesses, unions, and friends of the instructor in other fields;  and  is thinking of ending still others, like the Independent Payment Advisory Board (IPAB) and the tax on profits and revenues of medical defict makers.

The Supreme Court decision declaring the Big Dance, the Affordable Care Act constitutional  – was a step forward – but the Court's concomitant decision to let states opt out of Medicaid expansion was a step backward. This is very much a dance in progress., or possibly in reverse.  The music is causing stutter steps among the dancers,  and some  dancers  are dropping out until they see if the music stops or if this is indeed the last dance.

The umbrella title for the series of books purposefully implies that there is often no Rhyme or Reason behind the Affordable Care Act’s various provisions,  that the dancing instructor is a powerful Rhetorician with large megaphone, and that the Realities do not always match the Rhetoric.

Tweet:  My new book “The Physicians Foundation- A New Voice for Physicians,” is now available at 203-245-3959 or rjjulias@ondemandbooks.com.