Avoid­ing the plunge

Loom­ing fis­cal deadlines pose chal­lenges for health­care, na­tion

Modern Healthcare - - OPINIONS EDITORIALS - DAVID MAY As­sis­tant Man­ag­ing Ed­i­tor/fea­tures

As the Fed­eral Re­serve re­minded us last week, the na­tion’s “fis­cal cliff” is steadily loom­ing larger on the hori­zon. And ev­ery so of­ten, the talk­ing heads also want to make sure we’re aware of what lies ahead—a judg­ment day they like to call “Tax­agge­don.” Not fa­mil­iar with what they’re talk­ing about? It’s the col­lec­tive year-end ex­pi­ra­tion of the tax cuts first en­acted by for­mer Pres­i­dent Ge­orge W. Bush, the So­cial Se­cu­rity pay­roll tax “hol­i­day” and the final ex­ten­sion of emer­gency un­em­ploy­ment ben­e­fits.

And let’s not for­get we’ll also hear the start­ing gun for “se­ques­tra­tion,” the au­to­matic bud­get cuts set to hit both dis­cre­tionary and de­fense spend­ing thanks to law­mak­ers’ in­abil­ity to achieve a debt-re­duc­tion deal this year. Physi­cians also face an­other dead­line to avoid dou­ble-digit cuts in their re­im­burse­ment.

Scary stuff, for sure, but it’s far too early to panic. Re­mem­ber the mes­sage from this page last week: For the sake of your car­dio­vas­cu­lar health and gen­eral san­ity, try to stay up­beat about an ul­ti­mate res­o­lu­tion of this mess. Congress has plenty of time—if law­mak­ers can find the will and con­stituents keep up the pres­sure—to fi­nally achieve some form of grand bar­gain on spend­ing pri­or­i­ties and the na­tional debt.

Then again, we are talk­ing about Congress, in an elec­tion year. Maybe it re­ally is time to start sweat­ing.

While the Fed last week gave a some­what more op­ti­mistic out­look in the near term, with job­less­ness pos­si­bly dip­ping be­low 8% by year’s end and mod­estly im­proved growth in gross do­mes­tic prod­uct year over year, it’s the longer-term prog­no­sis that is clouded with much more un­cer­tainty.

“If no ac­tion is taken by fis­cal au­thor­i­ties, the size of the fis­cal cliff is so large that the Fed would have no abil­ity to off­set that ef­fect on the re­cov­ery,” Fed Chair­man Ben Ber­nanke said.

If that hap­pens, health­care will cer­tainly feel the pain, mean­ing providers and pa­tients. No sec­tor will es­cape un­scathed.

And let’s not over­look an­other crit­i­cal set of what-ifs. As in what if the U.S. Supreme Court does rule against the health re­form law, likely de­rail­ing many of its laud­able ob­jec­tives, es­pe­cially pro­vi­sions to slash the num­ber of unin­sured by more than 30 mil­lion. The ques­tion has been raised many times: What’s in the play­book from law­mak­ers and the pres­i­den­tial con­tenders should that hap­pen? How will they ad­dress the lack of ac­cess, tame the mon­ster of run­away health­care costs, and some­how not re­vert to the era of cruel in­sur­ance pol­icy rescis­sions and re­jec­tions be­cause of pre-ex­ist­ing con­di­tions?

As the Fed re­in­forced, we’re still in a frag­ile eco­nomic re­cov­ery, and no mat­ter who is in the White House next Jan­uary, that will still be the case for some time. No po­lit­i­cal spin can change that.

Signs of con­tin­u­ing strug­gles with health­care be­cause of un­em­ploy­ment or un­der-em­ploy­ment are still abun­dantly clear.

Just one ex­am­ple was a short story pub­lished last week on the web­site North­jer­sey.com: “Vir­tu­ally ev­ery week­end around North Jer­sey, there’s a pasta sup­per or a pan­cake break­fast to ben­e­fit some­one over­whelmed by med­i­cal bills. Friends and neigh­bors gather to help tod­dlers with dev­as­tat­ing ge­netic con­di­tions, teens felled by catas­trophic ac­ci­dents, par­ents lev­eled by rare can­cers. Some have in­sur­ance, some are unin­sured. …

“In part, the fundrais­ers are a nat­u­ral out­growth of an Amer­i­can health­care sys­tem that has left nearly 50 mil­lion unin­sured and an­other 29 mil­lion un­der-in­sured, with high co­pay­ments and de­ductibles. …”

That’s only one sec­tion of one state. Such sto­ries are cer­tainly noth­ing new, but we need to keep ask­ing: Given what we spend on health­care in this coun­try, don’t we want to do bet­ter than that?

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