There could be no more fitting end to the healthcare year of 2007 than President Bush sitting down in his Crawford, TX, ranch on Dec. 29 essentially taping a bandage on some fundamental healthcare problems still facing us. It was typical of a year that started with the best intentions to make progress in healthcare, but like so many personal resolutions ended in a pathetic whimper.
So basically what we have are two extensions--the State Children's Health Insurance Program stays at covering six million kids, and the Medicare physician fee reduction schedule gets officially procrastinated until June. Why should we have expected anything different? It sets up 2008 to be another year of policy workarounds and empty dialogue without much accountability toward fixing a healthcare system that threatens our national prosperity.
The fight over SCHIP shows in flashing lights just how petty the politics became. Progress toward any meaningful reform will require a progression of political steps, the first of which, I assert, must at least be some consensus on how we as a nation want to provide adequate healthcare coverage to our children. Both sides continue to accuse the other of using children either for or against the expansion toward government-sponsored universal care.
"Ultimately, our nation's goal should be to move children who have no health insurance to private coverage," President Bush said in an October radio address. That private coverage depends on mom and/or dad having a job that offers health coverage, and being able to afford premiums that grew 6.1 percent last year and now average $12,000 a year for a family of four, according to the Kaiser Family Foundation. So our nation's goal is to essentially push children into a private insurance market that is more expensive and more difficult to obtain?
The repeal of the Medicare physician fee reduction schedule until June likewise is a way to put off the pain, hoping that the lump will just go away. By mid-2008, Congress will be in the full heat of a presidential election cycle, with neither party wanting to risk its candidate's appeal.
"Regardless of the outcome in November 2008, there's no doubt the U.S. health system will experience transformative changes and disruptive innovation in coming years," says Paul H. Keckley, Ph.D., executive director of the Washington, D.C-based Deloitte Center for Health Solutions. "But for the next 12 months, it's wait and see."
When faced with a problem that threatens the health and safety of patients, good hospitals work with a sense of urgency. In Washington, unfortunately, the new year of healthcare continues to be dominated by political pie fights--as in who can keep the bigger piece--rather than meaningful movement. We can hope that other pressures on the system from employers, consumers and even internal pressures from hospitals and physicians, will keep some momentum toward change going in 2008.