The world’s biggest super-collider in Switzerland, activated several weeks ago, successfully smashed subatomic particles together as designed to recreate a mini-Big Bang, and seemingly without creating a black hole, an unintended consequence that some observers feared could potentially form and swallow up our planet. Unfortunately, the black hole did manifest — not near the collider in Europe — but instead on Wall Street.

The still unresolved fiscal crisis will likely suck up a great deal of the resources needed for health system reform. ACC President Doug Weaver and I talked further about this issue on Cardiosource Video Network this week. One unexpected effect of this crisis might be that the predicted physician/cardiologist supply shortage may be less severe — people won’t be able to retire.

The black hole is also affecting the candidates’ outlook on health care. Although it was only touched upon in last night's VP debate, Sen. Obama has acknowledged some of his health and environmental priorities may have to be funded in a multi-year sequential fashion as a result of the financial crisis. Sen. McCain’s campaign has thus far said they still plan to proceed full steam ahead with their health priorities. If so, it would involve funding their way by making cuts in existing Medicare costs. That would be scary for physicians and high-cost services like imaging. Deferring big spending right now might be a good idea — both campaigns need more work on their ideas. In fact, I think perhaps 2009 should be devoted to a national ‘conversation’ about what reforms should look like, given that there won’t be much money for real implementation, and all the big strategies need work. [more]

Nonetheless, Senate Finance Chair Max Baucus also told us that health care reform will proceed next year despite the ‘black hole’ effects. He is interfacing with other Senate leaders, including Kennedy, Bennett and Wyden, promoting reforms. Baucus proposes focusing on reforming the delivery system and improving quality and prevention. We can work with him on these things. He also wants to revisit last year’s CHAMP proposal to try to resolve the SGR. Dr. Weaver sat at breakfast one week back with Chair Dingell of the House Energy and Commerce Committee. He said the same thing. It’s starting to sound real. Reforms that don’t cost an arm and a leg are possible.

Sens. Wyden and Bennett are co-sponsoring a universal reform bill that has some interesting, even praiseworthy features. It preserves a private sector and private insurance (but with some much needed insurance reforms), and it requires all citizens to sign up for insurance or suffer tax penalties in IRS filings. The bill preserves Medicare, Medicaid, the VA, but adds mandatory provisions to these programs to promote better chronic disease care and prevention. Wyden told me last week that he is now more willing to modify his original idea to allow employer coverage to continue. The current version would replace employer coverage with one of the new community-rated private plans aimed at individuals and families, but require employers to pony up a defined contribution (about $375 per employee per year) to supplement costs of insurance, and to continue to collect health insurance contributions for employees directly out of the paychecks. Wyden and Bennett acknowledge their bill will be amended if seriously proposed. And, they seem enthused about adding some of the ACC payment reform ideas to their next version — they claim to like our system reform principles.

I also think their idea is worthy of “general” support (NOT endorsement on details) for three reasons: it preserves the private sector but still covers everybody; it is bipartisan (half of its endorsers are Republican); and the hyper-skeptical CBO (Congressional Budget Office) has marked it up as actually saving the nation money. In other words, their idea could be seriously discussed even with the ‘black hole’ on Wall Street and a recession. A modified version of this idea might be worth considering as a starting point on discussions about access and insurance reform. For-profit health insurers will not like it much, because it regulates away a lot of their abusive practices and profiteering strategies. But, how bad is that?    

My bottom line here: The current US financial and banking crisis will definitely mean a lot of expensive health care ideas will have to be put off for awhile, BUT it doesn’t mean big reforms won’t still be possible in the next year or two. Reforms that don’t cost a fortune, like improving quality and adding creative value-based payment incentives, are feasible. That’s where we can play a big role.

< Back to Listings