Sixty House seats and six Senate seats changed parties this week, along with a number of elected state governors. What does it all mean, and why should you care what I think when you have so many other pundits to read? Well, maybe because most of the pundits aren’t thinking about health care, much less cardiovascular medicine.

The ACC guessed pretty accurately on the vast majority of these races. We took a big chance, for example, supporting John Dingell when a fellow physician was running against him. But Dingell prevailed, and he will be in a position to help us in various ways, I guarantee. It is similar with many of the other races we bet on with our PAC and our advocacy efforts.

That said, I don’t think this election contains much good news for physicians and medicine. There’s a lot of rhetoric about how the Affordable Care Act (ACA) was a big negative for Democrats in their races, but it seems more apparent to me that the sluggish economy, the persistent unemployment, and fears in general about the growing national deficit and government spending (in tough times) were the culprit issues. All the recent polls indicate that the public is gradually warming up to some of the provisions in the ACA that they actually like.

For example, Brandeis health care guru Stuart Altman, Ph.D., has recently pointed out that persons over 65 express the most angst about the ACA, based on fears about adverse effects on Medicare, while these concerns had absolutely no basis in fact. Two-thirds of seniors polled leading up to the election had no idea that the ACA relieves them of prescription costs by filling up the donut hole or that physical exams and preventive services are covered with no copay. Eighty percent have no awareness that the law provides an additional decade of stability to Medicare where it was headed to bankruptcy in 2017 with the status quo. Many of these folks and many younger voters voted out incumbents who have committed in their campaigns to cut federal spending. And, guess what? The most available places to cut will be Medicare and Medicaid!

Despite all the banter about repealing the ACA, that will be a heck of a difficult thing to do. It will be impossible as long as Obama is president and the current Senate, even with six more Republicans, will certainly not be able to muster a 60-vote plurality on much of anything. So the repeal of the health care law banter is more hyperbole and political positioning. The incoming Speaker of the House, Mr. Boehner, has very circumspect about the possibility of “repeal.” What’s going to happen is that most voters (who by the way support many of the provisions of the ACA when asked about them) will start to become more informed about things they like in the bill and be much more hesitant about repealing it.

But the bad news for doctors, patients and medicine relate to the fact that the new Congress has promised America it will not increase federal spending. So, the SGR is not going to get fixed at a price tag of $350 billion, and instead fee-for-service Medicare and Medicaid will continue to be devalued and flat, reducing access to physicians and the viability of private practice. Patients who can’t afford a concierge physician will be hard pressed to find Medicare and Medicaid providers increasingly as time passes – unless some of these new members of Congress wake up to the fact that some federal spending is a positive investment in our future. I’m talking health care, including prevention, chronic disease management and expanded access.

The good news for ACC and cardiology practices is that we do know how to bend the cost curve by systematically improving quality and evidence-based care. We know how to reduce disparities and unnecessary expenditures through application of our clinical tools and the use of our registries. Is anybody listening? I hope so, because we can move beyond the “faith based” provision in the ACA to offer real ways to improve quality, improve heart health, and reduce unnecessary cardiovascular spending, which just happens to be 43% of Medicare spending cost. And, we can provide similar value for kids and adults with congenital heart disease as well.

Bottom line for me: While everybody’s grousing or cheering or staring like deer in the headlights, I hope we roll up our sleeves and get busy on doing the things we know we can do to help get us out the dead-end scenario of rising health care costs that outstrip a reasonable return on investment.

 

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