Nov. 17, 2000 (Washington) -- Gridlock on changes in our health care system. That's just one of the outcomes of this year's election.
The present situation in Washington has made it impossible for this year's Congress to pass meaningful health care legislation. The election, in my view, seals in gridlock for the next two years, no matter who wins the presidency.
Some perspective and predictions:
- Health care legislation won't move very far -- or very fast -- in the next Congress. If you're counting on Congress moving quickly next year to reform Medicare, increase Medicare payments, provide a prescription drug benefit to seniors, or enact a Patient's Bill of Rights -- count again. A presidential election that ends in bad feelings will lead to a congressional session filled with partisanship. The contentious presidential election may be entertaining and frustrating for the country right now. But the current deadlock spells gridlock up ahead.
- The new Congress will have even less interest in health care than the present one. The election will lead to new chairmen in key health care spots. In the House, either Billy Tauzin (R-La.) or Michael Oxley (R-Ohio) will chair the powerful Commerce Committee. Neither has ever pushed a health care agenda. Both are more interested in telecommunications and manufacturing issues. In the Senate, William Roth (R-Del.), who pushed for a compromise on a prescription drug benefit under Medicare, lost his seat. His likely successor, Charles Grassley (R-Iowa), has less interest in pushing that issue. Health care issues thus lost their champions in the new Congress.
- The winner of the presidency will not be able to provide leadership on health care issues. Whoever prevails clearly will not have a popular mandate. Congress is almost evenly divided between Republicans and Democrats. Thus, half the elected officials in Washington will believe the election was stolen. That's not a good start for a new administration. We'll see whether the new president can overcome the bad feelings and develop bipartisan consensus on health care issues. It won't be easy.
- Drug prices will continue to be an issue. The Democratic candidates in states that border Canada used price differentials between the U.S. and Canada as a campaign issue. The new Democratic senators who will keep the issue alive include Hillary Rodham Clinton (N.Y.), Debbie Stabenow (Mich.), Mark Dayton (Minn.), and possibly Maria Cantwell (Wash.). A Republican senator who won re-election, Jim Jeffords (Vt.), also emphasized this issue. Look for more rhetoric from both sides of the political aisle on the differences between U.S. and Canadian drug prices. The issue won't go anywhere until Congress passes a prescription drug benefit for seniors.
- Ralph Nader's credibility as a consumer advocate has been undermined. Nader and his Health Research Group, headed by Sidney Wolfe, MD, derive whatever power they have from their access to the media. Nader has moved himself from the role of consumer advocate to political spoiler. Democrats are furious with him because they believe he cost Al Gore thousands of critical votes. The Republicans never liked him in the first place. It will be difficult for him to regain credibility, even in Washington. Nader not only lost the election but also lowered his credibility, and the credibility of the health care issues that he advocates in the process.
- The states will address many health care issues. When Washington is in gridlock, state legislatures often take on the challenge. For example, this year Maine passed legislation that seeks to lower prescription drug prices for seniors -- legislation the drug industry is against. Look for other states to attempt to address their citizens' health cares problems because Washington can't.
- The pharmaceutical industry's financial role in the campaign underscores the need for campaign finance reform. Hundreds of millions of dollars were spent on this year's election. That included $68 million in public funds for each of the two major presidential candidates. But that's just the start. The Gore and Bush campaigns collected and spent hundreds of millions more in "soft" money, contributed to the political parties by corporations and powerful people. The pharmaceutical industry was one of the biggest contributors because of its concern that Gore's prescription drug program inevitably will lead to price controls. However, the drug company could spend its money more productively on research. Overall, there has to be a better way for us to finance elections in this country to bring some scale to them and also to eliminate the stench of "soft" money.
In the end, our country is still here and our health care system remains sound. But if you're expecting this year's election to advance health care issues, unless you're an advocate for the status quo, you'll be very disappointed.