If reform passes this year, will it matter?

All year long, people have asked me to write and speak about the prospects for health care overhaul in 2009. I’ve consistently forecast the prospects for reform at 30% or less, which has put me at odds with the near-universal view that the Democrats had the power to make it happen this year.

The political events of the past few days reinforce the main reason why I am a reform skeptic—something quite different from a reform opponent. (I firmly believe that reforms are desperately needed. The status quo is unsustainable.) Health reform has not been a “sure thing” because the ruling party is not unified on key issues. Democrats in Congress are deeply divided, and the White House has not provided clear or consistent leadership on what needs to be done or how to do it.

Consequently, the political price to be paid for passing a law in the next few weeks is incorporating pet projects (a.k.a. pork) and eliminating controversial provisions. Any final product is certain to be unfocused and inconsistent. It is also likely to be very expensive, which is why the current reform proposals impose cuts in existing programs and create new revenues almost immediately while delaying the actual reforms for several years.

If a reform law passes under these circumstances, people will discover that they are being expected to pay for reform long before the reforms are implemented. It’s a set-up for repealing any 2009 reform law before the 2010 mid-term elections. Sound impossible? It happened with the catastrophic insurance law twenty years ago, and I believe it would happen again. Even if a reform law passes in the next few weeks, its chances of surviving the next session of Congress are slim.

Reform in Washington is a red herring in my view, but the problems that compel reform are getting more serious by the day. Some key Democratic leaders say that we should pass something now and deal with its defects later. I disagree. Providers, payers, purchasers, and consumers should start working together to find solutions in their local markets. They should study our country’s health systems that have become excellent without waiting for national reform and work as partners to build on their successes.

We’ve always believed that health reform is ultimately local. Why shouldn’t reform be local, especially when the current political system seems to be incapable of solving problems nationally? What do you think?