Health Care Reform ICU Update and Implications


So the ICU metaphor has unsurprisingly been used after the recent developments surrounding the reform effort.  Incredibly, it appears that despite a year of work, the healthcare reform effort might not survive.  If in fact, there is a post-mortem, and its not completely clear yet that there will be, it will be a sad and unfortunate development.

The system as currently configured, is on a financially unsustainable path.  That is very clear.  But without real reform, access to care will be denied for millions who are stuck between not having  “good” coverage (in the form of a decent employer-sponsored plan or Medicare) and “okay” coverage, in the form of Medicaid.   Those are people earning too much for the latter and lacking access to (or the ability to afford) the former. 

If it is decided to “pull the plug” on the healthcare reform effort (keeping with the ICU metaphor), it will represent a tragic missed opportunity and the blame must be shared by both parties.   Nearly every stakeholder in the sector was asked to make sacrifices in order to facilitate reform, except for one.  Nothing at all was done to trim the ineffectual medical malpractice system, for fear of angering a substantial constituency.  Howard Dean himself admitted that the Democrats were taking on so many stakeholders, that they could not also take on the trial lawyers if they hoped to get anything done.   Yet making some degree of substantial reform to this flawed system was the one olive branch that might have secured some degree of Republican cooperation on the overall effort.  Instead of that, states were given language that would punish them if they tried to undertake tort reform on their own.

If something cannot be done to pass meaningful reform, the issue will be so politically untouchable that who can guess when it will be approached again?  The system will continue to react and change in other ways, possibly by large companies coming up with other ways to provide care for their employees in a more cost-responsible model.  So far, cost-shifting has been a large part of companies’ efforts.   The number of uninsured will continue to climb, and the withdrawal of providers willing to service them will continue to increase, likely mitigated as many providers are incorporated into hospital employed situations.   That will further increase the burden on hospitals who will be shouldering even more of the uninsured problem. 

Can there be real bipartisan work that will save the effort?  This seems unlikely if a “back to the drawing board” approach is taken, since its hard to believe that there is energy left for another 8-12+ months of hard work.

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