Hollywood on the Potomac (our U.S. capitol) has in many ways shut down politically in preparation for the November elections. The unpopularity of the Affordable Care Act (ACA), even if based on sound bite political conjecture, is really complicating things for the Administration and the Democrats. The Tea Party is all about shrinking federal spending and entitlements, which would in a megatrend-sense mean that physicians would have to collect more and more of their compensation from patients as cash on the line. Historically, that didn’t work too well – doctors got a lot of chickens and farm produce in those old days before insurance reimbursement.

On the other hand, a different kind of pressure is building to pay doctors through the mysterious and as yet undefined “accountable care organization” (ACO) model. ACC plans to be at the table and very much involved in helping to define what the ACO is, and how to position physicians to lead in implementing them, presuming this will be a new pathway to higher reimbursement incentives for improving quality.

We won’t hear much about ACOs on the campaign trail in the next 6 weeks, but we will hear a lot about the need for cost containment. The Democrats should rightly brag about the importance of expanding access to uninsured Americans, and about needed insurance reforms and about their at least framing in the law the importance of increased prevention, chronic disease management and some means of incentivizing improved quality of care.

But let’s face it; the dirty little reality is that the pressure is really about cost containment in health care. ACC knows the real secret here is that improving quality is the only sure way of reducing costs in the long run, but I don’t think that has fully sunk in to the Congress or the public.

The current prediction is still that the House is likely to shift to the Republican side of the aisle. But it is amazing how much the predictions change EVERY week! What does that mean for health care? In a word: more gridlock. The Senate will gain a few Republican seats, but likely stay in Democratic control, but even that looks more up in the air this week than last. There is NO WAY the Senate will have a 60 vote majority for the Republicans or veto-proof majority, so the seated president will surely veto any attempt by the House of Representatives to completely overturn the ACA.

A very likely Republican-dominated House could clearly mess up the authorizations for funding in the bill in a big way. For those who might rejoice over the gridlock scenario, I wouldn’t get too excited. The market forces that are making health care completely unaffordable for American families, small businesses and even organizations like ACC will relentlessly push us toward massive change. Rather than just girding our loins or looking in the rearview mirror and wishing the good old days would come back, we better roll up our sleeves and get busy to protect the integrity of health care for patients, the viability of the profession of medicine and the ongoing potential for innovation here.

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