The build-up to the President’s State of the Union speech was fairly chaotic. With no one, probably including the POTUS himself, sure about what he should say about health reform after the Scott Brown election upset, the focus rapidly shifted to jobs, jobs, jobs and the economy, as perhaps it should. Health reform became #2 priority at best. Telling comments indicate just how muddled things have become since the Massachusetts miracle. The President himself has said that Congress needs to “take another look” at health reform, indicating he understands the present proposals won’t fly. While in his SOTU speech he emphasized he wouldn’t abandon the patients and small businesses that are being harmed by the status quo, and he acknowledged that his team and he did not do a good marketing job of the virtues imbedded in Congress’ proposals.

Senate Majority Leader Harry Reid said bluntly that the Senate is not ready to take up reform again at this time, implying that he wants a month or more off. That’s telling. On the other hand, Speaker Pelosi said ‘reform cannot wait and that we will move forward with it rapidly.’ She believes the House can pass the Senate bill with the understanding that passage would be accompanied by and contingent upon also passing at the same time a simple majority (“reconciliation”) bill that corrects the issues in the Senate bill the House members cannot tolerate. I was disturbed to hear that she believes a “public option” should be included as a necessary correction. This is just not listening to the drum beats of the public or her Blue Dog moderate colleagues, and this would never be accepted by the Senate.

Meanwhile, Republican strategy on reform (and almost all issues) is to just say “no” as a means of trying to undo Obama and the Democrats in the mid-term elections. I think this is going to incur just as much wrath of the public as the strategy of the Democrats to try to do too much and spend too much while the nation is still in a very difficult economic circumstance. Virginia’s new governor Bob McDonnell, who served as the surprising choice of the Republicans to give the official response to Obama’s SOTU speech, simplified health reform down to two basic needed things Republicans want: tort reform and the ability to sell insurance products across state lines.

These are both very good ideas. But, Bob, even as much as all of us physicians believe tort reform is an essential and conspicuously missing part of the reform strategies produced by the Democrats, fixing the problem will of itself not eliminate the massive economic problems that will bankrupt the system in the near future. And, when Republicans had the control of Congress and the presidency just 2 years back, they didn’t get tort reform done, or even really try. So, while tort reform is truly a critical element of what physicians need to promote viable practices and reduce defensive medicine costs, it by itself will not foster the needed expansion of access, improvements in quality and coordination, or overall reductions in costs required. Again, allowing insurers to market and sell insurance products over state lines is a good idea to reduce premiums for small businesses and individuals and to reduce administrative costs for insurers. The amazing thing is that the Blue Dog Democrats included that strategy in the House bill for the proposed purchasing exchanges that would cover individuals, small business, and those currently uninsured.

It would be breath of fresh air if a few Republicans would step forward with something a little more comprehensive than these two good ideas to more effectively challenge the Democrats. Paul Ryan (R-Wisconsin), who will be at ACC.10 to share his ideas on reform, does have such a strategy -- he needs more of his colleagues to embrace a broader agenda.

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