Friday, October 5, 2012

The Debate----Who won?

Last night’s presidential debate turned out to be a big surprise to the Democrats who have been behind Barak Obama since 2008’s Presidential campaign and the past almost four years.

It has been the first opportunity to see Barak Obama mano a mano with a Republican opponent. since he took office The first debate was largely about the economy, a subject that Mitt Romney knows well, and has a market place recovery plan based on solid economic theory.

Obama seemed to be on the defensive, basing his facts on the present recovery plan initiated by him during his term in office. He seemed to be on the defensive, as well as unskilled in debate tactics and appearance at the podium.  His advisors either did not prepare him well for a debate, or he decided to ignore their advice.

This is typical of Barak Obama and reflects his actions and lack of bipartisan communications. He seems to march on and inevitably will self-destruct.

Anticipation will run high about the debate on health reform. Given his performance last night, health reform is in danger as Obama and the Democrats passed the law without one Republican vote. In fact Romney took the occasion to announce that his first action the day after he is inaugurated would be to repeal PPACA and put a hold on further implementation while revisions are studied.

Governor Romney’s  bold statement even before the debate on health reform announces the aggressive campaign the Republicans will run against PPACA. Mitt Romney is certainly the expert on working out bipartisan support for health reform he accomplished in Massachusetts.

His performance gives great hope to the health care community for significant revision and/or repeal of PPACA as it stands.

What the debate crystallized is the opportunity to significantly alter the present course of health reform.  It may polarize the debates further, although it may created an opening for more discussions.  Romney in his comments on PPACA emphasized the negative effect on Medicare Beneficiaries from PPACA.

What physicians need  to do now is to advance the causes of patients, advocacy for them and providers to strengthen that patient-centric model being espoused by supporters of PPACA, without real meaning for the term.  PPACA is not about patients and providers. It is much more about insurers, more bureaucracy, poorly devised cost control methods, fines, penalties and negative incentives.

Causes for concern include the lack of primary care providers to support 25 million or more patients entering the system, the uncertainty of how the federal government and states will partner ( and even in some cases, states have already balked at cooperation with the federal government),  the rapid rollout of HIT in the form of EHRs that may be unproven and even inaccurate,  HIEs that are still in their infancy, Looming changes for the ICD 10 diagnostic codes, planning and implementation of Accountable Care Organizations (ACO).  In the real world whatever projected savings in health care will be eaten up by the sheer volume of technology and simultaneous projects, all inter-related.

Physicians are aware of the complexity of change and the laws of unintended consequences, health planners are optimistic that they can forecast unforseen changes, which has been disproven time after time. 

The debate will continue………..


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