What If A New Health Reform Law Does Not Work?

Now that the House passed health reform legislation, there is a reasonable chance the Senate will also pass health reform, and health reform will become the law of the land. As the law is implemented, it will not and could not be perfect. There will be negative effects, real and perceived, and failures to achieve some of the promised legislative goals. What changes will the government make to the law?

Suppose there are more than a few negative start-up events and the health reform law actually does not work. By not work, I do not mean according to personal experience, media reports or according to stories one hears. I mean based on hard facts. Suppose as the statistics role in on life expectancy, disease survival and cure rates, accident survival rates, infant mortality, etc., the statistics show that the US became worse off than before the passage of the law. Suppose the US health statistics move further away from other comparable countries, instead of closer.

Suppose medical costs continue to rise at the same or faster rate as previous to the passage of health reform and health insurance becomes more expensive for everyone. Suppose the number of uninsured remains high.

What will the government's response be?

It is almost impossible to conceive that the law will be repealed. How will the government respond to start-up problems, unintended consequences and a failure in the improvement of certain health criteria as promised?

Obviously, the government will pass modifications to the law to minimize transparent negative effects, but how will the Congress extend the law to fix perceived and real problems? Can we think through how the Congress and President will respond to negative health reform outcomes?

Too much focus is on the starting point of the legislation, when we all know that the law will be modified after passage. Do most likely starting legislation points end up in the same place after a few years or does the initial form of the legislation matter?

My personal belief is that there are many more possible starting points for health reform legislation than there are for ending outcomes. A Medicare for all scenario is extremely unlikely since Medicare is too expensive for the US government. More likely is a movement towards a VA Hospital system. The health care system will move towards a government run enterprise, with government run or owned health delivery systems and hospitals.

Also, since the government tries to turn everything into revenue, whether crossing a bridge or using the telephone, how will the government modify its revenues to charge us more for health care? Will they tax unhealthy foods? lifestyles? negative health predispositions, such as obesity? hypochondria, etc.?

It will be interesting at least, and possibly frightening, to watch the legislation evolve over time after its passage, if it does become law.