Washington, the Election and the Future: What Should Americans Expect for the US Healthcare System?

In the upcoming edition of the Journal of Medical Practice Management, I authored an article entitled, “Four More Years”, which covered the results of the November election results, wherein President Barack Obama was elected to a second term in the White House and control of the Senate and House of Representatives was split between Democrats and Republicans respectively.  Perhaps more relevant to that column’s audience, and my audience here, I went on to offer my predictions as to how those election results will impact the healthcare industry and its various stakeholders in the coming years.

That column was written literally as the election results were coming in, which is not always the best time to editorialize or offer individual predictions about the future.  At that point in the game, there is typically still too much heated emotion and political competition that can easily prevent one from gaining a realistic understanding as to how the events transpiring will truly affect a major aspect of our country’s economy and government going forward.

Weeks have passed since my first predictions about what the healthcare industry can expect over the next few years from policymakers and politicians in Washington.  So, I felt it was appropriate to revisit the subject, and my predictions, in order to see if they have changed.  Furthermore, I also was curious to take into account how other commentators and experts have digested and interpreted the events, perhaps even making a comparison of the industry’s reaction and expectations with my own predictions as to what this all means for the future the US healthcare system.

The straightforward answer is that my original sentiments did not change.  We will look at this in a little more detail shortly; however, I found it interesting that even with all of the constant media hype, analysis and predictions, my assessment of what the outcome of the 2012 elections will mean for our healthcare system are the same weeks later.  Perhaps that was not enough time for us to really digest what this all means, though, as it turns out, I have actually found my original predictions further supported and encouraged by what I have read and heard from many other stakeholders within the healthcare industry.

As I mentioned in my original column, although there was no ambiguity around the outcome of the election after the polls closed, I have found myself less clear as to how healthcare provider organizations can expect the recent election results to impact the system forward.  Prior to Election Day, many healthcare industry analysts – myself included – had conducted extensive analysis on how the outcome of this election could likely impact the system; however, it was clearly all speculation and in some cases just shooting in the dark.

It is not necessarily the same “for-or-against” argument that makes this discussion relevant.  The question around how this election will impact healthcare industry stakeholders goes far deeper than party politics pushing one candidate over the other.  Indeed, I maintain my own personal view that if GOP candidate Mitt Romney were to have won this race, the outlook for healthcare would most likely be just as confusing, even if the specific questions may perhaps change.

Further, it is not just the outcome of the race for the White House that will have a major impact on what healthcare policy will look like over the next 2 to 4 years.  Indeed, most policy experts have long argued that the makeup of Congress will play a much more prominent role in directing healthcare reform and other related policy going forward.  And with the Republicans maintaining control of the House of Representatives and the Democrats possessing a majority in the Senate, this is a major factor in what the healthcare industry should expect out of Washington as we continue into 2013 and beyond.

One of the things we can likely expect is that major legislation related to healthcare reform that either builds on or opposes President Obama’s previously passed reform package is unlikely, at least before 2014.  The Republican-led Congress will most likely have the ability to stall any major legislation that the White House would attempt to propose; however, beyond that, there will be very little additional capability for the GOP to push their own major health reform package.

The nature of Washington’s inside-the-beltway standards will make such major legislation an unlikely battle to be fought by either side of the political aisle.  Any healthcare legislation that involves major party opposition or support requires a great deal of underlying infrastructure that is necessary, in order to pass through the many political scenarios, individual agendas and stakeholder personalities.  And when you are talking about something as big as full-scale healthcare reform, or better yet one party attempting to over-turn the President’s now-adopted package, this would require not only a major movement on both sides of the debate, but it would also entail an entirely new political war in Washington.

However, political wars in Washington can be very costly, and the volume of money, people and coordination that would be necessary for major healthcare legislation to pass is simply going to be too much for either party or any leading politician to pursue for at least the next couple of years.  And it is not just the money that will likely prevent major healthcare reform legislation from being attempted.  From 2010 to 2012, both Republicans and Democrats spent historical amounts of money in the battle over Obamacare, and the 2012 presidential election represented the highest amounts of election-related spending in history.

More valuable than the currency of dollars and cents in today’s Washington is the currency valued in political capital.  Washington is a tumultuous place to be right now, with the American economy still on the edge of a proverbial cliff and the recent evolution in voter characteristics that some have argued became evident with Mr. Obama’s reelection.  Politics in Washington today is not driven by boldness and tenacious risk-taking in efforts to achieve one’s objectives, as it was years ago when I was a young, wet-behind-the-ears political operative working on the Hill.

The way to earn political capital and gain strength as an elected official in today’s Washington, and what I believe will be the Washington of the foreseeable future, is by attracting the least amount of attention and causing the smallest amount of waves.  Risk is perhaps the dirtiest word in Washington now and for an elected official to be described as bold will likely result in he or she serving the rest of their delicately handled terms from inside the turtle shell of the DC Beltway.

Forgive my sidetracking editorializing about the nature of Washington today, but all this is to say that this election more or less seals the safety of Obamacare, at least until we know if the 2014 mid-term election result in any significant changes in the political make-up on Capitol Hill.  Obamacare is safe, not because the President received a mandate of support from voters in the election, but simply because neither side is interested in taking the risk or forking over the investment that a new war over that already hard-fought territory would require.

And as for Democrats who continue to bask in their victory of Mr. Obama’s healthcare reform package being validated and solidified by the Supreme Court earlier this year, it appears that they too will have minimal desire to put themselves out on any sort of political ledge that could come back to bite them in 2014 or 2016.  And since the American electorate does appear to remain heavily divided when it comes to healthcare reform, it is safe to say that the most likely strategy we will see from the Democrats will involve them digging in to defend any volleys that the Republicans might attempt to fire.  This will likely be further supported by the large powder-chest of financial reserves that the Democrats can continue to store up for when the much more likely and sizeable battle comes during the next major election cycle.

So, then what does all this mean for the healthcare industry?  What does it mean for the industry’s stakeholders – physicians and hospitals – both of which desperately need greater support from Washington?  Simply put, the answer is that no one knows.  That being said, I would argue that if the recent elections do indeed result in little support for achieving the kind of changes that doctors and healthcare organizations need out of Washington, then the crisis has just been escalated markedly.  And unfortunately, the results of such escalations in this growing crisis will now begin to entail more prominent, negative outcomes, which will be pervasively experienced throughout the entire healthcare system, and even the broader US economy.

But what is the true nature of this crisis involving the nation’s healthcare system?  This is a reasonable question, in that both parties in Washington have learned that the general population of voters typically do not cast their support, based on the candidates’ or parties’ stances on such a broad and macro-impacting issue like healthcare.  Support for or against a specific bill, such as the healthcare reform package, can certainly sway support from one side to the other for some voters; however, healthcare has never been a key political issue, such as the economy or national security.

When one looks more deeply at this argument, it becomes how apparent how counterintuitive this really is.  While the impact of policies that affect voter’s pocketbooks or determine the safety of borders do receive the majority of the heated political debate from the talking-head political pundits on cable news, what happens with our nation’s healthcare system is the single issue that will undoubtedly and unabashedly touch every single American in one way or another and at some point in time.  Moreover, healthcare is the one issue that will touch every American, regardless of income bracket, marital status, age or any other demographic that can change how certain issues are prioritized by voters and politicians alike.

Bringing this back full circle, I believe it is safe to say that what healthcare-related policy that does come out of Washington over the next 2 to 4 years will likely be relatively minor and even insignificant, in regards to truly addressing the type of change that healthcare providers and industry stakeholders need, in order to ensure the US healthcare delivery system is able to adequately meet every need that Americans have and deserve to receive from their healthcare system.

And I should emphasize that it is not one person, political party or policy that will determine the future success or failure of the nation’s healthcare system.  We cannot say that President Obama winning his re-election bid is outright bad for healthcare.  Likewise, there is no way to legitimately claim that if Mr. Romney would have been victorious in his 2012 bid, the industry would wake-up across America to find the system’s challenges magically resolved.

The threat that has emerged, however, from the most recent election is simply the threat of stagnation in achieving any real leadership and direction on where the healthcare system needs to go, in order to preserve its future viability.  It is inaction on the part of leaders in Washington, as well as those who put them there, that will expand the crisis that America is currently facing with the healthcare system and such will undoubtedly result in an acceleration in this crisis’ severity, such that any significant period of time without meaningful change could very well drive the country towards a devastating lack of alternatives in the relatively near future.

The country has reached a critical point in the evolution of our healthcare system, where the impact felt in one way or another by every American – whether they vote or not – has reached a new level of acuity.  In the past, healthcare reform was often treated as a macro-level issue that really does not reach the individual voter, as long as they, in one way or another, continue to be able to visit their doctor and receive medical care when needed.  The price of healthcare has practically never directly involved the actual patient and the idea that there would exist a variation or deficiency in the quality of care one received was thought to be something that only comes up in socialized healthcare systems of some European countries.

This is no longer the case in today’s debate over what the future of America’s healthcare system should look like.  Support or opposition towards certain healthcare policies could very well mean the difference between sickness and health for many people, even those younger Americans, who often assume healthcare policy only affects the elderly or infirmed.  And it’s not just about the quality of healthcare, because even those representing the most extreme ends of this debate must admit that our system is not yet experiencing a crisis of quality, which unfortunately has indeed become a literal life and death issue in other nations, such as the United Kingdom.

But, it does affect the young and the old alike; men, women and children; and, patients in every corner of the country.  Moreover, the future over the healthcare debate will extend much further beyond a single, self-contained political talking point issue.   The healthcare crisis is also an economic crisis.  It is a social crisis.  It is a public health crisis.  And, it will ultimately be a crisis of life and death if it is not taken seriously today and if leaders in Washington opt for doing the smallest amount of work that will still allow them to get re-elected in the next cycle.

More important for the American public to understand is that this is indeed a crisis, and an imminent one at that.  As such, it must be treated this way.  It is important for the general American electorate to understand why their primary care physician’s inability to maintain a private practice due to financial cuts, oppressive regulatory burdens and imbalances in market efficiencies will ultimately affect their ability to receive quality, affordable healthcare services.

Americans should also know how poorly planned and even more poorly executed policies in Washington on hospitals and other healthcare facilities will have a direct impact on their access to various medical services that are needed within their respective area.  And finally, voters should be able to make the connection between Washington’s lack of response and willingness to take the lead on critical issues needed by the most important aspect of the healthcare system (i.e., those who deliver the care) will ultimately be a bad thing for that individual person, their family members and anyone else about whom they care, because they will all be impacted by this crisis.

So, while the political debate over healthcare policy in Washington will no doubt be influenced by a wide range of political agendas, special interests and individually motivated influencers, the crisis emerging within our nation’s healthcare system today is much simpler than that.  The debate will always be politicized, and there will be winners and losers of that ongoing debate along the way.  However, the crisis that we are experiencing and the overall net effect of that debate will unequivocally touch every resident of this country.

As such, this is not just a crisis for doctors or insurance companies or any other specific stakeholder.  Further, it is not an issue that can be over-simplified with out of context statistics, political campaign issue platforms or media talking points.  It goes far beyond politics and if we, as voters with power to effectuate the expectations of our leaders in Washington, choose to proceed down a path of inaction, timidity and insufficient focus, then I’m afraid the crisis we are witnessing today will be nothing compared to the challenge we will find ourselves facing in the future.

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