In case you haven’t heard, in a stunning result in yesterday’s special election in Massachusetts, Republican Scott Brown won the Senate seat previously occupied by the late Edward Kennedy.
Needless to say, pundits are going crazy analyzing the results, and its implications on health reform. I’ll leave the political commentary to them, but I’ll comment on what this means for health reform’s future.
In essence, what turned into a 95% likelihood of passing, now stands at no better than 50/50, if that. The Democrats are now faced with an array of unpalatable options, which Slate’s Timothy Noah has concisely outlined.
I’ve previously written that the Democrats’ approach to health reform was seriously flawed; there were not enough mechanisms to control costs, a lack of meaningful malpractice reform, and an implicit contempt for the medical profession that most progressive reformers harbor. But most of all, reformers failed to listen to the needs of perhaps the most important constituents: patients and their doctors.
Not enough was proposed to strengthen the patient-doctor relationship, and there was little language on facilitating the practice of medicine. The most important commodity doctors have is time, and the reform bills did not value it. The lip service paid to primary care was encouraging, but in the end, the proposed remedies fell far short of what was needed.
All that being said, I still supported the legislation, arguing that seriously flawed reform was better than nothing:
The question of supporting the current reform efforts, or not, comes down to whether one thinks the status quo is sustainable. I believe the answer is no. The number of uninsured is rising at an unacceptable rate, and, combined with spiraling costs, will lead to the health system’s collapse.
In the end, I have messages for both sides of the political spectrum.
To the Left, listen to the doctors. Your antagonism towards the medical profession is harming your cause. Polls show that physicians have tremendous influence on patients. Although I agree that delivery system reforms are needed, these decisions should be made in conjunction with physicians, not solely based on the opinion of health economists with little clinical experience.
And continually harping on physician salaries does little to bring doctors to the progressive side. As renowned Princeton economist Uwe Reinhardt says:
Physicians’ collective take-home pay [is] only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.
We need to focus on decreasing the disparity between primary care and procedure-based specialties. That needs to be the dominating narrative, not the incessant progressive assertions that “doctors make too much money.”
A piece of advice to my progressive friends. The best way to win over doctors is to take medical malpractice seriously. More than a few will gladly accept a single-payer system if explicitly paired with comprehensive liability reform. Even with the most conservative, non-partisan, CBO estimates, fixing the malpractice system will save $54 billion over 10 years, which is not insignificant.
To the Right, with the potential defeat of ObamaCare, you may have won the battle, but will lose the war. The current health reform efforts, in the grand scheme of things, were very incremental in nature. Without it, the number of uninsured will rise, and health costs will continue to spiral upwards. That will eventually bring America’s economy to its knees, and, as I said a few months ago, “once that happens, more draconian measures will be forced upon us. Measures that assuredly will not be friendly to doctors.”
The Health Care Blog’s Matthew Holt comes to the same conclusion today: “The next approach will come at a time of extreme need, and the response will be a lot less palatable than many inside the system would like.”
And those wanting to “start over” are in for a rude awakening. There will be no next time, as no other administration will want to tackle health reform after this debacle.
Indeed, if health reform fails, a more progressive solution will be forced upon the country – Medicare for all, for instance – making conservatives wish they had cooperated with President Obama’s approach today.
