Health Care Inside, Outside, and Below the Beltway

Inside the Beltway" is an American idiom used to characterize matters that are, or seem to be, important primarily to officials of the U.S. federal government, to its contractors and lobbyists, and to the corporate media who cover them—as opposed to the interests and priorities of the general U.S. population.

The Beltway refers to Interstate 495, the Capital Beltway, a circumferential highway (beltway) that has encircled Washington, D.C. (the capital of the United States) since 1964. Some speakers of American English now employ the word as a metonym for federal government insiders (cf. Beltway bandits).

Geographically, Inside the Beltway describes Washington, D.C. and those sections of Maryland and Virginia that lie within the perimeter of the Capital Beltway.

Beltway, Description and Definition

Everybody knows what “Inside the Beltway” and The Beltway” means.   It’s where politicians come  to  do good, and end up doing well.  It’s where President came to change, and ended up changing him.   It’s where he came to rescue the middle class and instead, inexplicably and unexpectedly, redistributed income to  the rich.   It’s where people in the top five richest zip code in the U.S. live.   It's where the President came to level the health care playing field so that the poor and insured and halth plan violated would get a fair shake and a fair share of what health care had to offer.  It's a place whose culture the President came to change so Main Street could share in prosperity inside the Beltway.

Somehow it hasn’t worked out.   Main street  businesses are crumbling.  The numbers of unemployed, looking for work, or dropping out of the workforces are staggeringly high. The national debt is up by $7 trillion.  And health care, that’s the same  kettle of fish.   Even though his health reform bill passed over 3 ½ years ago,  premiums are climbing, the health law remains as unpopular as ever,  and its implementation  is under attack and big chunks are being  delayed. In the words of comedian Dave Barry in his book Dave Barry Hits Below the Belt, there is  “ a vicious and unprovoked attack on our most cherished political institutions” – the federal government,  its agencies, and Congress.

Is this attack deserved?   Probably not.  The  intentions of the health reform law are noble – to redistribute benefits from the well-off to the less-well off and to make the health system as a whole more efficient by applying the principles of modern management  through the application of Big Data and high tech information technologies. The opportunity was there in the beginning to pass it without a single Republican vote. And some of its provisions did protect the public.  Its troubles were that it has not yet delivered on its promises – to keep your doctor and your health plan, to cut costs, to expand access.   And it has unanticipated consequences.  It has worsened the doctor shortage.  It has  depressed hiring.  It helped stagnate the recovery.  It threatened to turn us into a part-time nation as businesses hire more part-time than full-time workers to avoid Obamacare penalties.  And it has alienated unions,  who find  its provisions troubling because Obamacare has “disrupted “ the union missions was  of providing full-time work with rich health benefits.

Will health reform work as promised?  Perhaps.   Time and the number signing up for health exchanges will tell.   In the interim,  the President may need to tighten the  Beltway belt to keep from losing his political pants.   At times, even a President  inside the Beltway needs to tighten his seat belt.

Tweet:  Economic and health care conditions look different inside and outside the Beltway and may require belt tightening by all concerned.