Post-Election Predictions For Healthcare

With a drastic change in political control in Congress, the entire healthcare industry is concerned about what it will mean for healthcare operations. While I have no inside information, I have traditionally stuck my neck out and advanced some predictions for the next two years -- but beyond that, my crystal ball is not functioning.

The Wild Cards

Before making my predictions, I have to acknowledge that there are some real wild cards out there that could throw these predictions way off --

Internal stuggles within the Republican Party will likely leave it more focused on their internal issues than challenging the Democratic agenda, and that is my assumption in my predictions;

Bush has traditionally been reluctant to veto legislation and his initial "cooperation" talk makes me assume that he will not veto anything on the healthcare agenda;

Traditional Democratic social, regulatory, and tax stances are pretty consistent, but the new conservative candidates might balk at the traditional agenda entirely, force centrist compromise within the party, or simply follow the old guard Democratic leaders. My assumption is that they will be in line with the old guard leaders.

Another major terrorist attack on US soil in the next 2 years would obviously have massive and unpredictable effects on the political views and stance of the country and of Congress. My predictive assumption must be that it will not occur prior to the 2008 election.

Likewise, Iran, Syria, North Korea or any of the other totalitarian countries could force a global conflict during the next two years to take advantage of policy uncertainties at home. For immediate prediction purposes, my assumption must be that they will not.

The last major factor that is completely unknown is whether any faustian deals were struck between major industry players and the Democrats prior to the election. Again, my assumption must be that they have not.

The last three assumptions are necessary to make any predictions at all, but my confidence level in these assumptions is not very high.

The Post-Election Predictions:

1. Medicare reimbursement will continue on a downward trend

2. Stiffer regulation of drug companies, physicians, healthcare providers and hospitals will be a prime agenda item for the Congressional majority.

3. EMTALA regulations are likely to remain essentially unchanged and enforcement may increase in some areas. This is a high probability prediction, as Fortney "Pete" Stark (D-CA) is likely to resume the powerful role as head of the Medicare committee in the house. For those who don't remember Pete, EMTALA, Stark 1, and Stark 2 are all his children. His over-all approach to Medicare has been summed up by his quote in his prior days as committee chair -- "Medicare is what I say it is."

4. TAG recommendations for reform of EMTALA are not likely to be implemented, and the TAG may be allowed to expire or be disbanded by new legislation.

5. EMTALA enforcement will vary as it already does among regions, but some variations will change in pattern as CMS personnel size up their political positions for the next two years and possible implications of the 2008 election.

6. "Comprehensive" immigration reform will blow through Congress because the Democrats and the President already agree on this agenda item. -- even though the public does not want it. That means essentially open borders and continued hard hits on hospitals for uncompensated care. Don't expect any funding to off-set the cost to hospitals.

7. Tort Reform on a national level is a dead concept. Some local changes may still be effected, but Democratic policy at a national level won't let it see the light of day in the next Congress.

8. Increased incident and quality reporting mandates will probably clear the new Congress without threat of veto.

9. Comprehensive Medicare and Medicaid reform will not clear the next Congress. Now, at least one person thinks that I am wrong about that one -- last week, Sen. Hillary Clinton started declaring the party's agenda (like perhaps a candidate for president?).

"Health care is coming back," Clinton warned, adding, "It may be a bad dream for some." I could be wrong, but that sounds like she hopes Clinton-Care will be resurrected. I will stiffle any comments, but...??

10. Fraud and abuse prosecutions will increase. These are the fair-haired children of both parties, and increases in regulations will increase errors by providers and open the window for more prosecutions, refunds, and fines. This trend has been consistent, but will pick up somewhat as the shift in control of Congress occurs.

Bearish For Healthcare

Obviously, most of these predictions are "bearish" for healthcare, but do not represent major negative changes. What we see is just a steeper part of the same slippery slope that we are already familiar with.

Now About Security...

I said I was less than confident on those issues --

While it is impossible to predict terrorism or the form it will take without a lot more information than I have, I predict that perhaps as early as next year Iran, Syria, and/or North Korea will trigger a major international conflict with serious internal implications for the US both in terms of economic and homeland security challenges. How the Russians and Chinese factor into these will greatly influence how bad it is -- from inconvenient to blood in the streets of America in a literal sense.

This summer's Hezbollah/Israeli conflict was a warm-up, and the lack of a decisive victory for Israel has emboldened the Axis of Evil. Today's headlines talk about Syrian-provoked war in Lebanon with the goal of making Lebanon a launching pad for a massive Syrian/Hezbollah assault on Israel.

Iran will NOT be left out when the chance to kill Israel presents itself -- they will want to be driving on this trip. Iran is making more threats of going nuclear against Israel, the North Koreans are threatening more tests, and it appears that the "axis of evil" is revving up. (See Dispatch From Istanbul article on this site.)

Are they puppets of Russia or China or merely their own little gang? Regardless, it would take a blind person not see a collusive pattern here that is NOT good. Of course, there are dozens of other little despot wanna-be's around the world working to achieve major league status.

Bottom line -- I would suggest ramping up investments in serious external consultant reviews of hospital security and capital investment in quickly implementing their recommendations. Also get a practical external review of your emergency plan. Most of them (even after 9-1-1 and Katrina) are seriously inadequate for security, evacuation, hostage situations, and preparations for large-scale structural collapse/blast injuries like we see every night coming from Iraq and Israel TV.

These precautions are valuable even if the world situation calms down, because hospitals are already caught in the middle of gang wars, drug shoot-outs, and meth lab explosions that appear to be escalating in both the large cities and rural towns.

Batting Average?

Over the years, I am batting pretty good on my annual predictions -- but I did miss on Y2K. I really don't mind missing on the bad predictions.