It would be easy for Republicans to be upset about the election and for Democrats to take this opportunity to seek retribution. And that might feel good for awhile. Or both parties could step forward and take advantage of what is likely to be the greatest opportunity to improve health care that this nation has seen in a long time.
Health care is the most important domestic issue we face -– from the perspective of both the health of our nation and our economy. It will take a centrist and bipartisan approach to make real change –- and this is exactly what Americans demanded when they voted on Tuesday. It would be a shame for Democrats to spend the next two years focused only on Iraq and beating up on the Republicans on the war -– and miss the opportunity to make real progress. It won’t be easy.
In times past when there was a divided government, it was difficult to pass major legislation. The final two years of the Reagan administration and the Bush 41 administration were clear examples of this paralysis. But there were occasional exceptions, especially when the key leaders worked across the partisan divide, as when President George H.W. Bush and Senator Ted Kennedy worked for the passage of the Americans with Disabilities Act. Getting things done is not hopeless, just very hard.
So, what does this election mean for U.S. national health policy in the months ahead?
The big health issues before the next Congress:
• A renewed debate on Medicare’s drug benefit, especially over giving the Medicare program authority to negotiate prices with the pharma companies
• Medicaid spending and how to constrain it, and particularly its relationship to immigration
• Covering the uninsured — here’s a real possibility for bipartisan work. Recall the plan that Pete Stark and Dick Armey put forward several years ago on this key issue. Only a bipartisan proposal can work
• Health care quality and patient safety — this is growing in importance to purchasers, consumers and providers. It likely will be a part of any larger health reform proposal. Pay-for-performance will remain a key way of linking quality and cost. There will be lots of discussion about how to make sure it is constructive, and not damaging to the American health care system
• Public health and global health — pandemic flu gives the nation another opportunity to focus on population health and preparedness
With the counting of the votes for 2006, the 2008 presidential contest has begun and will affect what can and will be accomplished in the next two years. Hillary Clinton, John Edwards, and perhaps Barak Obama look to be the principal Democratic candidates, and John McCain, Mitt Romney, and perhaps Rudy Giuliani the GOP’s.
It looks like health care will be prominently featured in the 2008 contest. Given Senator Clinton’s work in health and health care, the others will have to put forward their own plans.
Especially given Romney’s Massachusetts plan for covering the uninsured — he will be touting it — others will have to respond. There will be a cottage industry among the pundits comparing the various proposals. Translating them into plain language for the public will be a major challenge.
Some notable departures — Bill Frist’s impending departure from the Senate will mean the loss of his leadership on health issues. Witness his work on quality and patient safety, AIDS in Africa, and other areas. Nancy Johnson has been a constructive leader of the House Ways and Means Health Subcommittee. She will be missed on health care financing matters.
Who will be the voice of health and health care in Congress? Joe Lieberman has an opportunity. Clinton and McCain will be much more visible on health going forward, too.
In the new Congress, Charlie Rangel, Pete Stark, Max Baucus, John Dingell, Henry Waxman, and others will return to their former, more prominent leadership roles. Each has shown himself capable of bipartisan work. Whether that will be the order of the day now remains to be seen. There will be a window of opportunity in 2007 to legislate on some key health and health care issues, but by early 2008 that window will have closed, as the presidential campaign will be then be in full swing.
The dust has barely settled on the election of 2006, but it looks like this election may have pushed us to a place where health reform, in selected areas, is possible. While lots of time and effort will be put into solutions for Iraq, maybe we can now hope for some health and health care, too.