Time for a reset on healthcare reform

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    American Health Economy Illustrated
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I said it three months ago, and I’ll say it again: It’s high time for a reset on healthcare reform. Four things have happened since last November’s election that reinforce the wisdom of doing so.

First, a federal judge in Virginia ruled in December that the individual mandate was unconstitutional, but permitted remaining components of the law to remain in place.

Second, a majority in the House voted in January to repeal the law in its entirety. Unlike the original law—which not only failed to obtain a single Republican vote, but also had 34 Democrats who voted against it—the repeal bill attained bipartisan support without a single Republican defection. A far larger majority in the House (245-189) now has voted to repeal the law than originally supported it (219-212).

Third, a federal judge in Florida, Roger Vinson, now has ruled that the individual mandate is unconstitutional; because the law included no severability clause, he voided the entire law on grounds that “the individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit.”

Fourth, in contrast to the hopes and expectations of the law’s designers (who clearly expected the public to “get over it” once the bill became law), public opposition to the law has increased over time rather than dissipated. Even before Judge Vinson’s opinion, Jake Tapper at ABC News had conceded the healthcare law is at its “lowest level of popularity ever,” and there is plenty of evidence from other polls to support this view.

In launching his healthcare reform initiative, President Obama said at the White House Health Care Forum in March 2009 that “We’re at a Thelma and Louise moment,” arguing that the United States was headed towards a cliff and had to act. He also added, to much laughter: “If you actually saw the movie, they did drive over the cliff. So just want to be clear, that’s not our intention here.” The events of the past few months offer the president a terrific reality check: should he drive off the cliff by continuing to implement the health reform law in hopes of a safe landing? Or is now the time to stop the car and perhaps even put it in reverse?

In the words of one skeptic, “ObamaCare was designed to be the governmental equivalent of kudzu—growing everywhere, propagating by multiple means, and sinking in its roots and becoming impossible to control.” The hope was to have the law take root so quickly that it would overwhelm any legislative efforts to slow it down once people had a chance to “find out what’s in it.”

But kudzu works both ways. Trying to prune it to a desirable shape or carefully root it out one branch at a time after it’s gotten started is not only slow, painful, and arduous work, but also has no guarantee of success (I live smack in the center of kudzu country, so I speak from experience). The most sensible course of action is not to let it grow in the first place and, if it does, resign yourself to uprooting it in toto rather than somehow try to “manage” its growth into a pleasing shape.

If you don’t like that analogy, try this: we’re halfway to the top of a brand new roller coaster (the biggest and most complicated in the entire world). We just got news that using a sophisticated monitoring system, a technician named Roger has detected that the cutting-edge braking system is defective. If he’s right, there’s going to be a terrible accident once the coaster reaches the bottom. But Roger might be wrong. Roger’s report and all the evidence used to reach his conclusion are being kicked upstairs to a panel of the nation’s nine best roller coaster technicians. They will decide whether Roger is correct—in which case the cars will have to be completely redesigned from the ground up—or whether he’s wrong, in which case it will turn out that riders are safe after all. Is there anyone who would vote in favor of continuing the ride rather than waiting for the panel to make an independent decision?

We’re at a Thelma and Louise moment: let’s not drive over the cliff.

Christopher J. Conover, PhD, is a research scholar at Duke University’s Center for Health Policy and Inequalities Research.

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