Health for life

Our understanding of the ACA?

If Disease Management Care Blogs bold prediction holds up and the Supreme Court splits the health care baby by letting the Affordable Care Act (ACA) stand while striking down the "individual mandate," progressives will announce the world is ending, while conservatives will announce Obamacare is ending.

The DMCB argues neither will be true.  When the sun rises the next day, Ms. Pelosis health care "constitutionality" sputterings will not cease, crafty U.S. House Republicans wont stop their devilish attempts to gut what remains of the ACA and CMS vast bureaucracy will continue to "innovate" with long-used approaches from the commercial health insurance markets.

The DMCB also predicts that therell be an emerging consensus that a stumbling White House somehow botched the media-public opionion-wars. According to that narrative, manipulating an unsuspecting "Jersey Shore" addled public with news conferences, speeches, town halls, favorable coverage, framing, biased polling, talking points, press releases, The Daily Show appearances, bloggery, tweets, negative ads, spin, messaging, appeals to "the base," and targeted air-time can convert uninformed numbskulls into opinionated numbskulls.  Talking heads on both sides of the partisan divide would have us believe that but for Americans being educated about the merits of one position vs. another, theyd not only make the correct judgement, itd be our judgement.

"Bunk!" says the DMCB.

It thinks that by now most Americans "get" the broad outlines of the Affordable Care Act: expanded, mandated and regulated private as well as government-sponsored health insurance that is paid for by the Feds and theore the taxpayer. Knowing the facts, its not unreasonable for thinking persons on either side of the political spectrum to agree or disagree with the ACA.  Call the DMCB naive, but it thinks that the general poll trending against the ACA has less to do with media and more to do with the informed judgement and native intelligence of a messy democracy that is underestimated by a cynical partisan elite.

The DMCB is not arguing that the news cycle and media dont have an impact. They do. Yet, when it comes to the ACA, both sides have had an ample opportunity to use all the powers of persuasion to nudge public opinion.  The fact that the ACA has failed to achieve a convincing level of support speaks less to competing messages than the underlying content. In other musical words, its not the arrangement, but the underlying chord progression.

What to make of all this wreckage?

The ACAs unfavorability, despite a generally supportive news media, suggests Congressional leadership cannot govern from the left.  This is a cautionary lesson for the emboldened Republicans, who may calculate that when their turn comes, theyll be able to govern from the right.

Theres good news for health orm.  President Obamas allies forced the issue and, sooner or later, Americans, after trying every alternative, will finally do the right thing. The Supremes and public opinion seem to be telling us that the ACA is not necessarily that right thing. Were still working on it and a plan that can be supported by most Americans will eventually emerge.

Dont worry so much!

Depressed? 

Dont be.  While the Disease Management Care Blog prays for the victims and families of the Aurora shooting and hopes that Penn States travails leads to greater protection of innocents, the DMCB is also an optimist. Humans are remarkably resilient. We rise above evil, We learn from mistakes. And then we carry on.

Itd also be tempting to let the last 72 hours cast a pall over the other Big Problems that beset us, including our sputtering economy, persistent unemployment and politicians who seem unequal to the task at hand. But if youre looking for a better spin on things, a recent The Economist editorial on the Comback Kid paints a different picture. American debt is being pared, family homes are now beginning to look like bargains, the banks are shedding bad loans, a weaker dollar and a nimble private sector (including the "app" factories of Silicon Valley) are driving U.S. exports up and natural gas is making energy cheap and plentiful. Oil imports are down and the U.S. is becoming a net exporter of hydrocarbons. 

Whats more, says the DMCB, the U.S. population birth rates and immigration levels are pointing to a sustainable demographic dividend, while our universities remain the envy of the world.  Assuming our politicians figure out a way to cut spending, increase revenue and keep inflation at bay without doing more harm, the longer term fundamentals are decidedly a cause for optimism.  Thats a big "if," but it could happen.

But if you think a another reason for economic optimism is the simple expansion of the health care industry, Drs. Baicker and Chandra, writing in the New England Journal about The Health Care Jobs Fallacy suggest you think again.  While politicians may like the prospect of the medical-industrial complex hiring lots of voters who pay lots of taxes, every dollar spent on patients is one less dollar spent by society on education, infrastructure, food, shelter, retirement savings and other government services. In addition, those dollars are not necessarily associated with meaningful gains in life quality or expectancy.  And while it could argued that "orms" will ultimately reduce costs, its possible that improved productivity combined with more persons with insurance will ultimately drive demand up.

Which raises a good point.

The economy may turn the corner sooner than we expect, and its long term prospects - despite our political class - are good.  In that setting, health care companies that run counter to the usual historical business cost-plus model by driving higher quality and lower costs will succeed.  Those will be the enterprises that attract customers that can increasingly afford their services. Itll be interesting to see how ACOs, population health companies, the PCMH and wellness offerings fare.

Stay tuned!

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