Any doctor or healthcare analyst looking at the elections for direction on how key healthcare issues are likely to fare next year must have been sorely disappointed Nov. 7.
Voters were evenly divided about which presidential candidate and which party had the best plan for the nation, including what to do regarding Medicare, patient rights and prescription drugs. The presidency hinged on a recount of ballots in Florida, and both houses of Congress are almost evenly divided between Republicans and Democrats.
"It's too early to tell" what Congress will do, says Steven Wojcik, director of public policy for the Washington Business Group on Health, a not-for-profit forum for large employers across the country. The group educates legislators on best healthcare practices.
Still, the lack of a definitive victory by either side is an indicator of some direction, says Susan Paisano, spokesperson for the American Association of Health Plans.
"Whoever gets to be president will need to demonstrate bipartisanship and avoid the 'do nothing' moniker," Paisano says. But after the first eight or nine months of the new term, partisanship could prevail as both parties begin to look forward to the 2002 election, she says.
Peter Kongstvedt, M.D., a partner in the healthcare consulting practice of Ernst & Young in Washington, agrees.
"There would be more of an impetus to get something done," Kongstvedt says. "When you're this close, all you need is a few defections (on Capitol Hill). Better to compromise and hold people together than to let them defect."
Another factor contributing to a potential improvement in bipartisanship is the simple fact that President Clinton is leaving office, says Paul Ginsburg, president of the Center for Studying Health System Change.
"There was something (negative) in the chemistry between Clinton and the Republicans" that wouldn't be present with Vice President Al Gore if he were elected, Ginsburg says.
In the House, Democrats needed to pick up seven seats to gain control but only gained a net of two seats.
The GOP will maintain control of the Senate even if Democratic challenger Maria Cantwell beats Washington Sen. Slade Gorton, splitting the Senate 50-50.
If Texas Gov. George W. Bush is the next president, Vice President Dick Cheney would act as Senate president and control the tie-breaking vote. And if Gore is elected, Connecticut Sen. Joseph Lieberman would become vice president, but the state's Republican governor would name Lieberman's Republican successor, giving the GOP a 51-49 edge.
One key Democratic victory in the Senate was that of challenger Thomas Carper, who defeated Senate Finance Committee Chairman William Roth of Delaware. In his campaign, Carper advocated the passage of a patient bill of rights and a prescription drug benefit under Medicare.
Sen. Charles Grassley of Iowa, the second-ranking Republican on the committee, has been mentioned most often as Roth's successor. Grassley introduced legislation last year to curb medical errors. Wojcik says Grassley's expected appointment as well as a new Institute of Medicine report on medical errors scheduled to come out next year should put that topic front and center.
Republican control of both houses was a costly but worthwhile win for drug companies, which spent tens of millions of dollars on the funding of Republican campaigns and on issue ads. The effort was an attempt to insure that a prescription drug benefit would be administered by private insurers, which Bush advocates, instead of Medicare, which Gore advocates.
But it wasn't only drug company funding that kept Republicans in control, Wojcik says.
"I was struck that there was a real division among Americans over 65 between the two candidates," Wojcik says. Election results indicate that Gore won 51% of the votes of those older than 65 compared with Bush's 47%. The narrow margin is surprising considering that seniors tend to vote with the party offering the most in terms of Medicare and Social Security, traditionally the Democrats.
Besides medical errors, a patient bill of rights is likely to remain a top legislative concern given lobbying by doctors' groups and constituent calls for action.
Prescription drugs for seniors also will remain an issue. Ginsburg says a prescription drug package for seniors is an "ideal" issue to tackle in a bipartisan manner as Republicans and Democrats don't seem to be particularly far apart. But predicting any action on these issues at this point would be just as futile as trying to predict the outcome of the presidential race.