Today, I am blogging from the end of the road - literally.
I write from the beautiful shores of Homer, Alaska, famously described by former resident and "All Things Considered" commentator Tom Bodett as being the "end of road." I am here because later this week I will be meeting with internists attending the annual ACP Alaska chapter meeting in Anchorage, and Homer, a little over 200 miles away on the Kenai Peninsula, is a nice side trip. (Each year, I try to attend as many as a dozen ACP chapter meetings across the country. This allows ACP members to hear my perspectives on what is going on in Washington, and in turn, I get an earful on what's on their minds, especially from notoriously independent Alaskan physicians!)
The end of the road might be an apt description of how some commentators now view President Obama's prospects to achieve lasting health care reform.
The Congressional Budget Office's report on the cost of health care reform, followed by the decision by the Senate Finance Committee to delay release of its draft plan, have led some to conclude that President Obama's push for health care reform is in deep trouble. Roll Call reports that the price tag and partisan bickering could "derail" Senate passage of health care reform.
After months of mostly upbeat reports, it's as if the press suddenly awakened to the fact that reforming health care won't be easy. But why? - all of the negatives from the past week were entirely predictable.
Health care reform will cost a lot of money? Well, yeah.
Republicans and Democrats will bicker? Duh.
Democrats will have difficulty reaching agreement amongst themselves? What else would you expect from a party that has made internal dissension a celebrated art form?
But amidst all of the gloomy reports, there actually was quite a bit of positive news for President Obama and his congressional allies.
First, the drug industry reached an agreement to reduce the costs of drugs paid for under the Medicare Part D program. This is important because the White House and Congress need savings and offsets that will not be fought by the affected stakeholders.
Second, House Democrats produced a draft bill that includes measures designed to win broad support among key constituencies - including doctors. It not only eliminates next year's 21 percent cut in Medicare's payment to doctors, but would also get rid of hundreds of billions of dollars in accumulated doctor pay cuts - a top priority of the medical profession. The bill includes scholarships, loan forgiveness, and payment reforms to support physicians in primary care. I will write more about the House proposal later this week, but I believe that there are enough positives in it to keep physicians at the table in a way that help move things forward.
Finally, despite all of the hand-wringing in Washington, a new poll shows that the public remains strongly in favor of health care reform. 85 percent of respondents said that health care must be completely rebuilt or fundamentally changed - with a strong majority favoring a greater government role in health care. The poll also showed strong support among Democrats, Independents, and even a majority of Republicans for a "public plan" option, one of the most controversial issues in Washington.
Instead of reaching an end of the road, health care reform continues to move forward - as it does, it will run into speed bumps, pot holes, and perilous turns along the way. The whole effort could yet crash and burn, but from where I sit, at the end of a road overlooking Kachemak Bay, the finish line remains very much in sight.
Today's question: Do you think health care reform is in deep trouble - or will it continue to move forward to enactment?