At the Incidental Economist, Harold Pollack makes an important point–the partisan and divisive birth of the Affordable Care Act has tainted virtually every effort to find consensus on reforming health care. For the foreseeable future, health care reform will remain a partisan issue, even at the cost of improving health care.
Within a sane political world, the fate of such efforts would have little to do with ideological fights over near-universal coverage or Medicaid expansion. Yet here we are. A successful bundled-payment pilot would represent a political victory for the president. Its corresponding failure would represent a political defeat for ObamaCare. This is not a good development for the enterprise of health of health services research.
Perhaps health policy would be less polarized had ACA simply expanded coverage by raising taxes without attempting broad delivery reforms in the same bill. Then the straight-up ideological and redistributive battle could have been fought without damaging every other component of health policy with the predictable fallout.
I’m not sure such a separation would have been fiscally prudent or politically possible. It might, however, have avoided the place we inhabit right now, in which so many promising delivery reforms are tinged by their association with President Obama’s signature domestic policy achievement.
This outcome shouldn’t be a surprise. When a single party attempts to transform a huge percentage of the American economy, on a straight-party line vote, long-standing political gridlock should have been anticipated. But, at the time, all of the health wonks insisted that we pass the bill this way, and that his better than passing nothing at all. Something was better than nothing, right?
Is that the case? History will decide.