Tuesday, November 2, 2010

Cognitive Dissonance in the Health Reform Echo Chamber: From Progressive to Zombie Legislation after Midterms?

This is the feeling of uncomfortable tension which comes from holding two conflicting thoughts in the mind at the same time

Definition of Cognitive Dissonance

As I write this, it is 8AM on election night, and returns are just beginning to filter in. This is a guesstimate what the midterms might mean for health reform.

Almost to the person, contributors to the “Perspective” section of the New England Journal of Medicine hue to the Obama health reform line, namely that the Affordable Care Act (ACA) is unquestionably a step in the right direction, that all will be well if only we follow its provisions to the letter, and that its implementation is inevitable and is needed to correct deficiencies in our health system. The Journal has served as an echo chamber for Obamacare supporters.

Suddenly, in the October 28 NEJM issue, Henry Aaron, PhD, of the liberal Brookings Institute in Washington, D.C. sounds the alarm and breaks out of the chamber by saying, in effect, “Hey! Maybe this thing we call ACA isn’t going to work after all.”

He breaks ranks with conventional progressive wisdom by opening admitting the ACA may fail in his piece "The Midterm Elections– High Stakes for Health Policy.”

Aaron sets the tone with his opening paragraph,

“The stakes for health policy in the 2010 congressional elections are higher than they have ever been. The political parties are polarized. Policy divisions are deep. The challenges of implementing the Affordable Care Act (ACA) are enormous. The outcomes may well determine whether his landmark legislation succeeds or fails.”

Zombie Legislation

And indeed, the ACA may fail, which in Aaron’s eyes would be a travesty and a tragedy.

“The nation would be left with zombie legislation, a program that lives on but works badly, consisting of poorly funded and understaffed state health exchanges that cannot bring needed improvements in individual and small-group markets, clumsily administered subsidies that lead to needless confusion and mandate that are capriciously enforced.”

This outcome might not be so bad. It would compel Congress to revisit the sloppily written law, backed unilaterally by only one party, unread by many of its ardent supporters, and fraught with adverse consequences – rapidly rising costs, curtailed benefits, and dropped coverage for millions of the the insured- already surfacing 7 months after passage.

Maybe a little bipartisan reconsideration, stalled implementation, and reversal of flawed aspects of the law, is in order before we wade too deeply into the health reform swamp. Maybe we are about to witness the unraveling of the ACA law. Maybe the affordable care act is about to be held accountable.

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