That sigh of relief from opponents of healthcare reform signals the end of one of the most tumultuous national debates in decades. But healthcare executives who think they've dodged a bullet should be warned: Now is not the time for complacency.
The ever-ambitious President Bill Clinton has temporarily thrown in the towel on reform after winning narrow congressional victories on the crime bill, NAFTA and a tax increase. And, like Arnold Schwarzenegger in "The Terminator," the president vows, "I'll be back."
Although he may not have as many Democrats on Capitol Hill next year after the November elections, Mr. Clinton likely will re-enter the reform battle with his State of the Union speech in January. That gives employers, insurers and providers who opposed Clinton-style changes about 100 days to provide evidence that reform is being achieved without more government interference.
Meanwhile, sitting back in the weeds of Washington are the single-payer advocates, a solid constituency that's enamored with the Canadian approach to healthcare. The Rep. Jim McDermotts of the world are the bane of free enterprise theorists, but their clean and simple solutions to the healthcare mess may start making sense to more Americans.
To counter the single-payer crowd, hospitals and other providers can point with pride to the significant slowdown in medical inflation, successful cost-containment programs and improved operating efficiencies. Hospitals are changing and adapting because of market forces, not dictums from Washington. Employers and managed-care contractors demand a more rational approach to medical treatment. Providers have responded with integrated delivery systems, community-care networks and an emphasis on primary care.
Yes, providers are making progress, but now is not the time for smug, self-congratulatory posturing. The internal reform movement must accelerate in the next 100 days. Waste and duplication must be squeezed out of the system. Excess capacity must be trimmed. Sensible affiliations, collaborations and mergers should be pursued if they are of benefit to the community. The elections, the holidays and the winter blahs should not be taken as reasons to relax.
For employers and insurers, the task is more daunting. The statistics on the uninsured continue to baffle the public. The economy appears in decent shape, jobs are being created, and inflation remains under control. Yet, the strength is misleading. Health benefits are being scaled back, more employers are hiring temporary workers, and many small businesses are reluctant to offer medical insurance. In the meantime, the ranks of the uninsured seem to snowball by the millions.
For their part, insurers continue to lobby against modifications involving community rating and pre-existing conditions that could prompt premium hikes. The business and insurance lobbies may have won the battle by stopping reform in 1994. But they could lose the war if the single-payer advocates can convince the public that the healthcare scenario isn't getting better.
Healthcare administrators need to spread that message far and near.