What a difference a year makes. And doesn't make.
Of course, healthcare reform is now the law of the land. That, everyone must agree—for better or worse—is a fairly significant difference. But as far as the reform rhetoric, the beat goes on. It's essentially the same old song in many circles.
It was about this time last summer when the heat was near its peak. I'm not talking climatology but rather the temperature of the debate over the reform proposals being dissected across America. Those plans morphed into what we now know as the Patient Protection and Affordable Care Act, and from the opponents there were endless warnings of “rationing,” “socialism” and a “government takeover” of healthcare, among others.
The attacks continue and have even intensified at times, as newly installed CMS Administrator Donald Berwick can tell you. But they're also frequently accompanied by two words: “repeal” and “replace.” Healthcare reform must be expunged and some undefined “common sense” alternative must be enacted, according to the law's indefatigable foes.
First of all, we get it. It's an election year and some GOP lawmakers might truly believe everything in the law is moving the country down the wrong path. But they're also telling voters what they believe they want to hear. After all, a majority of the electorate still disapproves of the law, right?
According to many polls, yes, but others, including one by USA Today/Gallup and another by the Associated Press recently showed most respondents favor the reform package, albeit by slim margins. Sentiment seems to be shifting as the law is implemented and people are starting to see some benefits.
Proponents of the “repeal and replace” movement should certainly know their efforts aren't rooted in reality. For years to come, their numbers in Congress necessary to accomplish such a goal just won't be there even should the GOP succeed in taking back both houses of Congress in November. Remember that President Barack Obama has an endless supply of veto pens in the Oval Office.
Just last week, the Wall Street Journal ran an intriguing analysis running scenarios showing how the Republicans certainly stand a chance of winning the Senate in the midterm elections. But even in the Journal's rosiest picture, the GOP secures only a 51-49 majority. Given that breakdown, don't look for vetoes to be overridden. And isn't it a little early to write off the Democrats?
We can't forget the facts that drove the push for reform all along: Healthcare in this country is broken. While this nation absolutely has some of the best healthcare providers in the world, the “system” is deeply flawed and even dangerous. Just last month the Commonwealth Fund released updated figures showing, once again, that while the U.S. spends the most per capita on healthcare, the U.S. ranks last overall based on a study comparing seven developed Western nations on measures such as patient safety, access and efficiency.
Even supporters of the Patient Protection Act concede the law is far from perfect. Time will tell how well it expands access and whether it can rein in costs. But the status quo was unaffordable and never acceptable, and laws can be tweaked far short of repeal.
Consider the decades-old National Health Service in Britain (popular in that nation but not so much here—again, go ask Dr. Berwick). As Modern Healthcare's Gregg Blesch reports in this issue (p. 32), that system is now being radically revamped to put primary care more toward the center of the universe.
As U.S. healthcare reform rolls out, let the debate continue over how to fine-tune healthcare delivery. But it's the over-the-top rhetoric that deserves to be repealed and replaced.