The ACP Advocate Blog
by Bob Doherty
Wednesday, January 20, 2010
"I'm not dead ... yet"
One of my favorite movie scenes is from "Monty Python and the Holy Grail," when an unfortunate soul pleads with the designated collector of corpses (this being after the plague, mind you) that "I'm not dead ... yet." The collector responds by whacking him on the head ... until he is, in fact, quite dead.
This scene comes to mind as I blog about yesterday's stunning GOP upset of the seat-that-used-to-be-held-by Ted Kennedy. If the election of Republican Scott Brown didn't quite kill off health care reform, some Democrats are quite willing to complete the task.
Ezra Klein blogs for the Washington Post that, "a Democratic Party that would abandon their central initiative this quickly isn't a Democratic Party that deserves to hold power. If they don't believe in the importance of their policies, why should anyone who's skeptical change their mind? If they're not interested in actually passing their agenda, why should voters who agree with Democrats on the issues work to elect them? A commitment provisional on Ted Kennedy not dying and Martha Coakley not running a terrible campaign is not much of a commitment at all." Steve Pearlstein, also writing in the Post, argues that the Massachusetts vote was not a referendum on health reform: "There are lots of reasons other than derailing health reform why normally liberal Massachusetts voters may have wanted to send an angry signal to the state's political establishment. For Democrats in Washington, the danger now is not that they will ignore the election returns, but that they will misread them and sound a premature retreat from a historic and game-changing opportunity."
Yet there is no denying that even if the Massachusetts outcome didn't kill health care reform, it has put it on a death watch. Many of Brown's supporters came from independents who, according to pre-election polls, were highly motivated by their opposition to the health care reform bills. But Massachusetts already has near-universal coverage - broadly supported by its voters - so it is hard to view the election as a flat-out rejection of reforms that they themselves enjoy. And, as I wrote in yesterday's blog, there is no denying that the public lacks confidence in the government's ability to deliver on the promises of better care at lower cost to them.
Politico reports on several options available to Democrats to continue to move forward on health care reform, but there is a clear divide among rank and file members in both chambers on how or if to proceed. And, as I write this, CNN is reporting that President Obama may offer a scaled down version of health care reform - bans on pre-existing conditions exclusions and expanding Medicaid to cover all of the poor and near-poor - as a potential fallback.
I understand all of the focus on the politics of health reform, and I suppose that if I were a Democratic member of Congress, that is the main thing I'd be thinking about. But I am reminded that the reasons for health care reform are just as valid today as they were yesterday: tens of millions of Americans lack access to affordable health insurance coverage, many more have difficulty paying their bills, quality is uneven, and costs are rising faster than we as a country can afford. These were true when Obama took office one year ago today - when, by the way, there were only 58 Democratic Senators (Specter of Pennsylvania hadn't yet switched parties, and Franken's win over Coleman in Minnesota was being contested in the courts) - when the popular refrain was "Yes, we can." Now, with 59 Senate votes, some Democrats are saying "no we can't" to health care reform?
In September of last year, I blogged about the plight of a Missouri bartender I met at an ACP chapter meeting:
"She said she has some serious health problems that require expensive medications, which are only partly covered by the health insurance plan offered by her employer. Her company plan also covers her 19 year old dependent daughter with a serious mental health condition. Her husband, an independent contractor who can't find coverage on his own, also relies on his wife's plan for coverage. She said that even with the insurance, her premiums and out-of-pocket health care bills are so high that 'I don't know how we'll make it.' She was planning to take a day off from work to plead with state Medicaid office to cover her daughter, even though she had already been advised over the phone that her daughter wouldn't qualify."
I wrote that, "I hope we don't lose sight of this Missouri bartender, and the millions of working American families, who can't afford health care and are looking to Washington for help. None of the bills making their way through Congress are perfect - far from it. But I believe the litmus test of whether the results are worth it is whether our Missouri bartender and her family can get good coverage at a price that they can afford."
I still believe this. The voters in Massachusetts elected Mr. Brown, knowing that he promised to be the 41st vote against health care reform, and their choice needs to be respected. But Massachusetts has near-universal coverage, is it too much to ask that a Missouri bartender - and the tens of millions like her - have the same? The current Congress and President can still bring home the Holy Grail of health care reform, but only if they - and we the voters - want it bad enough.
Today's questions: What advice would you give to President Obama and Congress? Give up on health reform? Move forward with the basic framework that has been passed by both chambers? Or pass as scaled down version?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- Losing and winning the battle for public opinion
- Why do red states gain the most under health refor...
- What do the health reform bills do ... to increase...
- Keep government out of health care? It's already ...
- Government spending on health outpaces private sou...
- Meet the New Year, same as the old year
- How the Grinch Stole Health Care
- Liberals Attack "Government-Takeover" of Health Ca...
- Pushing drugs to doctors and patients
- Waiting for Godot (a.k.a. Senator Joe)
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.