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Wednesday, January 6, 2010

The waiting game

The frantic activities of the Congress before Christmas have given way to a peculiar calm. Things will get revved up again when the health care bills from the House and Senate get thrown in the great merging maw. The question is what will happen?

I now have a sense that it is nearly impossible for anything of substance to come as a product of a possible fusion of these bills. I also believed there was no way the House and Senate would be able to pass anything prior to the end of 2008 which should serve as a caution for anyone who thinks I can predict the future, particularly the political future.

Assuming I am wrong and that the miracle workers in the joint House and Senate committee pull off the merger through some sort of magical process, what is this going to look like and what type of shock waves will be unleashed? Depending on the constitutional issues which may come into play and how the legislation is crafted, the opportunities for legal challenges will be created. It suspect that there will be a series of immediate legal challenges which will placed. It will get very interesting and perhaps very ugly.

The constraints required for merging the bills creates few opportunities to make a workable and constitutional bill. Each constraint represents a hard stop, veto opportunity. Cost constraints are not compatible with broad state Medicaid subsidies. Focused state underwriting welcomes constitutional challenges. No state underwriting will lead to loss of state support for the entire process. Similar rock, paper,scissor scenarios may develop in handling regulatory measures focusing on insurance returns and abortion policies. Measures required to create political coalitions that are essential to create compromises needed to maintain coalitions create law which welcomes legal challenge.

We are also presented with surreal time lines. The bills need to be merged meaning sections need to be harmonized and differences adjudicated. How many people need to touch and review the sticking points? How long will it take to create some sort of close to a final draft which then needs to be reviewed by all of the House and Senate? How in the world will all this happen in a transparent fashion before the State of The Union Address. Again, I express more disbelief. Am I the realist or just a nay-sayer (or both).

In the end this may all be irrelevant in the long run. There will be marked changes in the health care environment, independent and any reform that occurs through federal legislation. I do not wish for change to stop. That would be crazy. Our present system rewards many of the wrong things, stimulates overconsumption of expensive services, and will bankrupt us. The worst case scenario would be for federal reform to act as a barrier to positive change while accelerating our move toward bankruptcy.

At this point it is just a waiting game.

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