Health for life

In George Romeros campy movie Land of the Dead, the zombies undergo a very worrisome change. While they used to just pathetically stumble around looking for brains to eat, they organize and make menacing plans. The living survivors, holed up inside the fence at the former city of Pittsburgh, have a fight on their hands.

Maybe its the Halloween season, but the recent slew of late night walking dead horror has inspired the Disease Management Care Blog.  Its entered sweeps for a cameo appearance in AMCs cool zombie series.  Its assessed the relative merits of the undead staggering vs. running, being loners vs. in packs and being wrathful vs. both hungry and wrathful.  The DMCB has also discovered one key commonality of this fearsome species: while maximum head trauma undoes the undead, more of them just keep coming and coming. That DMCB thinks that, despite the spouses advice to the contrary, is an important lesson.

The political dimensions of the Affordable Care Act are becoming more zombie-like with each passing week.  According to the Kaiser Health Foundation, public support for health orm has not only remained stubbornly underwhelming, it has just taken a recent downturn.  While its too early to tell if this is bad news or statistical variation, theres no denying President and his allies are being forced to fight one-on-one with undead employer pessimism, oppositional Republicans and the CLASS Acts failures, while more ever more issues slowly stumble closer.  And who can blame the living Dems for their post-apocalyptic anxiety? It was only yesterday that the ACA was a signature achievement and the world was a wonderful place of Congressional majorities, fawning media support and supreme self-confidence.

While supporters of health orm may take comfort in the notion that the zombies have been unorganized and are attacking the margins, the DMCB worries that the Kaiser poll slide may portend a worrisome Romero-esque development: unable to grasp the details if the Affordable Care Act, Americans support for it was always based less on the underlying policy and more on the President himself.  A slip in support, theore, has less to do with the laws merits and more with a shift in what people fundamentally think about Mr. Obama.

With just over a year until the elections, thats a scary thought for this Halloween. It seems the folks inside the White House fence have a fight on their hands.

Partly because its a brain tonic for jet lag, the Disease Management Care Blog is trying to come to grips with the "Higgs Boson."

As it understands it, these invisible motes permeate our universe and interact with strangely named subatomic particles in ways that confer mass. The identification of the "boson" apparently explains a lot, like how electrons are so light (little interaction) and why toilet seats are so difficult to raise (much interaction).

Which provides an apt metaphor for Washingtons bosonic permeation of the health care universe.  CMS rates set payment benchmarks, its device approvals determine coverage, IPAB says when a treatment is evidence-based and insurers have little say on the definition of administrative costs. In the meantime, the Federal Register fills space with the microwave radiation of rule-making and now the Supreme Court has set off a Big Bang.

Unfortunately, the DMCB isnt making much progress on the theoretical physics of bosons, photons,leptons, quarks and gluons or, for that matter, on the legal Big Bang physics of mandates, taxes, assessments, collections fines or penalties. If the DMCB is reading Justice Roberts correctly, a low-amount "exaction" that is configured as a "shared responsibility payment" for behavior that is not "unlawful is "within" Congress taxing authority.  Right.

No wonder the Romney campaign is so confused. Without the genius of Peter Higgs or the opaque jurisprudence of John Roberts, theyre as probably perplexed as us normal folks. Better to move on to topics better suited for the rhetoric of the fall campaign, like whether its all really Bushs fault or truly Bushs fault.