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The Surgi Sound Off blog is an open forum for ambulatory surgery center professionals to share personal insight and expertise within the ASC community. These columns also appear in our weekly subscription-based enewsletter. Please note that the opinions of our bloggers may not always reflect SurgiStrategies' position.

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P.C. in D.C. – The Healthcare Dance


Political ambitions have led to the demise of more than one American, but nowhere has the pursuit of political gain played out more publicly of late than in our national healthcare arena. SurgiStrategies' February print issue just hit the streets, and it features brilliant insight about the status of the Affordable Care Act (ACA) from several industry thought-leaders, so I won't wax poetic on that. What I will say is that when it comes to healthcare, Americans deserve more than contrived choreography by political hopefuls. How attuned Americans are to the dance – and whether they're willing to let another suitor cut in – will likely not be fully revealed until the last votes are tallied in November.

A mid-December Associated Press-GfK poll indicated a shift in the number of Americans opposed to re-electing President Obama, with 52 percent against the idea. Compare that to a similar poll in May, in which 53 percent were still in favor of his re-election. Despite the poll's increasing majority opinion that the president should be voted out of office, perhaps the more fascinating piece is the lack of a clear Republican alternative to replace him.

As for President Obama's healthcare reform efforts, only 15 percent of respondents believed that the feds should be able to require Americans to purchase health insurance. Support for the law itself was down to 29 percent (from 36 percent in June), with about half of participants stating they were against the healthcare reform law in general ... that figure reflects the Democratic sentiment as well, at only a 50 percent support rate.

Of course it's difficult to gauge whether the general population truly understands the ACA. A late-2011 Kaiser Health Tracking Poll reveals that more than half of those surveyed think the law includes a new government-run insurance plan to be offered along with private plans. An additional 13 percent were unsure of whether that was part of the law. At this time, more than 40 percent also didn't know about one of the law's most popular provisions – the requirement for health plans to create straightforward benefits summaries. Between the Democrats doing a horrible job explaining the law and Republicans doing an excellent job obfuscating it, healthcare reform can't really progress.

Although it's impossible to please all of the people all of the time, Texas Gov. Rick Perry may have gained a few nods after the state's progress with the Centers for Medicare & Medicaid Services. The resulting 5-year waiver finalized late last year promises to keep billions of federal Medicaid supplementary dollars pumping into the state. It's not every day that an anti-ACA Republican presidential hopeful and federal regulators are on the same side of something that also appeases a pro-ACA Democratic White House. And although there's been speculation about Texas' Medicaid measure ultimately preparing the state for upcoming changes as a result of healthcare reform, you have to hand it to Perry no matter how the law plays out ... That is, if you don't get too caught up in his previous efforts to have the state opt-out of Medicaid. The reality is that even Texas simply can't afford to pick up the tab on its own.

At the same time, fellow Texas resident Rep. Ron Paul isn't losing any opportunity to build anti-ACA rhetoric into his presidential bid. At a speaking engagement in New Hampshire, Paul reminded attendees that there was no constitutional provision for Medicare and Medicaid (which is a powerful statement – until you think about how many other aspects of modern government aren't represented in the Constitution). At least he's firm on his view of moving healthcare out of the federal government and into the states' hands. I wonder if that would help things in Maryland, where a recent state legislative audit revealed that the state paid $426,000 in Medicaid to 10 people who were dead. Or that $2.5 million was paid from 2008 to the middle of 2011 for 323 folks who may have already been dead. But I digress...

Not long ago, the big news was the reveal of "Ryan Lite," a round-two attempt to revise Medicare by House Budget Committee Chairman Paul Ryan, R-Wis. – this time in conjunction with Sen. Ron Wyden, D-Ore. Coupled with Mitt Romney's quick public support of what's essentially a voucher plan with a nod to privatization, this provides an interesting peek into what could be a game-changer, should a Republican win the presidential election. Even Newt Gingrich may flip-flop and get on board, as the new plan presents much less radically when compared to Ryan's original proposal.

There's no way to tell where we'll be in three, six or 12 months – including whether part or all of the ACA will be deemed unconstitutional – or replaced, if a new administration takes office. (I maintain my pessimistic stance on the likelihood of those possibilities.) However, with the 2012 election year in full swing, the one thing we can know for sure is that the dance floor is just getting warmed up.

Karen Butler ( ) is Editor in Chief of SurgiStrategies.



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