One of the more surprising twists and turns in the continuing debate over health care reform is that many physicians who now object to the Affordable Care Ac t (ACA), were, just a few years back, advocates for more federal regulation. In fact, in the early 2000s, more than 200 "provider" and consumer groups - including many state medical and national medical specialty societies that now oppose the ACA because of concerns about "excessive regulation" - were among the fiercest champions of federal legislation to mandate that health insurers comply with a Patients’ Bill of Rights. A bipartisan bill introduced by Senator John McCain (R-AZ) and the late Senator Ted Kennedy (D-MA) would have ensured that patients have the "right" to appeal insurance company denials to independent reviewers, to choose a specialist of their choice, and to access emergency room services when needed. This effort to enact a federal Patent Bill of Rights failed, because of opposition from the insurance industry and President George W. Bush.
I bring up this history lesson because most of the key provisions in the McCain-Kennedy bill are now the law of the land, thanks to the Affordable Care Act. Yet instead of applauding the new protections, many of the same physician organizations who called for a federal Patients' Bill of Rights now want to "repeal" the same consumer protections established by the ACA.
I understand that times, circumstances, and opinions change. It is not unreasonable, for instance, for physicians who advocated for the Patient Bill of Rights to now object to a almost one trillion dollar price price-tag associated with the coverage provisions in the ACA.
But the history of the Patient Bill of Rights is illustrative in one very important sense. It shows that physicians (like most of the rest of) have not held consistent views on the question of whether we need more or less federal regulation of health care. When the issue was in opposition to insurance company "gatekeepers" that limited access to specialists, most physicians were quite willing to have the federal government prohibit such practices.
Similarly, a staple of mainstream conservative thought is that the federal government should not pre-empt state "rights"- but not always. For instance, when it comes to medical liability reform, most conservatives (including right-leaning doctors) favor enactment of a federal law to impose limits on non-economic damages on states that do not have such caps.
I also don't know of many physicians who would repeal Medicare, or the Food and Drug Administration, or the National Institutes of Health.
My point is that Americans - including most physicians - accept the idea that the federal government has a responsibility to regulate health care, and even the most conservative doctors have championed MORE federal regulation (e.g. in the case of the Patient Bill of Rights and tort reform) when it has been in their interest. The debate, then, should be over how much federal regulation is needed, instead of oversimplifying the issue as one of being "for" or "against" federal regulation.
Today's questions: How much federal regulation of health care is needed?