Halloween is a big deal in America. Just as well, since it’s kept the kids happily occupied whilst the grownups have dealt with the other spectre lurking in the shadows: the Congressional mid-term elections.
As predicted, these elections have moved the country from Democratic control to a uniquely US brand of “No Overall Control” politics: a Democratic president, Democratic control of the Senate (but by the slimmest of margins), and significant Republican control of the House of Representatives. This is Good News for the Republicans, who now get greater influence on federal government and the chance to repeal Acts passed in the last two years. By the same token, it is Bad News for President Obama, who now knows he won’t get anywhere with his planned climate change bill and the closure of Guantanamo Bay’s detention centre. And it’s probably Bad News for the country: whilst it is in everyone’s interests that both parties now work together, the mood music is for stand-off and stubbornness.
For the Democrats, the election results were a lesson on the difficulties of communicating complicated policy. The voting public perceived the time and money invested over the last two years in creating the new healthcare Act (Affordable Care Act) distracted from the “real” need to address the economy and create jobs. Almost half the population doesn’t understand the Act, and at the time of the elections, as unemployment passed 10%, the majority felt the Act should be changed or significantly repealed.
Senior staff in the US Department of Health & Human Services put a brave face on it: the morning after election day, Sherry Glied, the Assistant Secretary for Planning & Evaluation, said it’s business as usual – the Act is still law.
But, with an infusion of more right wing Tea Party members, new Republican arrivals on Capitol Hill are keen to repeal the “Obamacare train-wreck”. They see the Act as taking resources for care of “deserving” older people to subsidise care of those who “can’t” or “won’t pay for themselves”. Although the President would veto repeal, Republican dominance in the House means it can delay or stop the funding necessary to implement the Act. On top of this, twenty states are using the courts to challenge the constitutional legitimacy of compelling anyone to do anything, including buying healthcare insurance. And so the race is on: can the Act’s plans for payment reform and provider redesign gain momentum quickly enough to deliver results before this new Congress get their legislative wheels in motion - and before campaigning starts again for the 2012 Presidential election?
Back in England, what, if anything, might be gleaned from this US experience? Common consensus is that the White Paper plans are ambitious: creating relatively inexperienced GP-led consortia with significantly lower management costs to buy higher quality more cost-effective healthcare than today’s system would be daring enough. But doing that whilst finding £20 billion-worth of efficiencies, nurturing the development of a larger not-for-profit healthcare market, and dealing with the effects of cuts in other sectors such as housing and the cross-subsidy of social care - all before the next election – even makes eyes water here in the US. Implementing such complicated policy requires clear communication, open and honest dialogue, appreciating the inevitability of both successes and failures and learning from both.
Spin and hyperbole do no one any favours. Back across the pond, the US is starting two years of political instability and new debates over how healthcare reform will now be implemented. The Halloween candy’s gone, invitations to Thanksgiving dinners are in the mail, and the outdoor ice-skating rinks have opened in New York City. However, the spectre of the mid-term elections will continue to haunt this country and is destined to become its Ghosts of Christmases Present and Future …