The mid-term elections, repeal and unkind cuts


Aron Ralston is back.

If that name is familiar, it's because he's the outdoorsman who amputated his own right arm seven years ago after getting it lodged in a rock formation during a Utah hiking expedition. A movie based on his experiences was released last week.

I bring Ralston up because it reminds me of a horribly mischievous period in my life when I was editing a spoof of the Wall Street Journal called The Walnut (official motto: "Business News For Yes-Men in the No").

The Walnut once reported that Ralston had nabbed a fat endorsement deal from the National Association of Managed Care Organizations. NAMCO had hired Ralston because it had estimated that Americans would save $12 billion a year if they operated on themselves. Ralston made a perfect spokesman for such a cause.

Of course, that's all fictitious (although the article did indeed bounce merrily around WellPoint's email servers for a time). However, the horrible mischief was not. I fear it has returned with the outcome of last week's mid-term elections, accompanied by far more power and far less of a sense of humor.

Rep. John Boehner, R-Coppertone, has called the healthcare reform bill a "monstrosity" and wants it repealed. My lifetime as a Californian has taught me to consider the vocabulary of someone who makes George Hamilton look like the Michelin Man with a grain of salt. But the man is going to be Speaker of the House, which means some attention must be paid.

Boehner cannot repeal healthcare reform--yet. The Senate is still controlled by Democrats. Even if they acquiesced, President Obama would veto any attempts to do so, and votes for an override are lacking. But the reform's most important provisions--including the exchanges and the use of pre-existing conditions for underwriting--don't take effect until 2014. A long and potentially treacherous three-plus years lie ahead, with Republicans making every effort to de-fund reform along the way.

Should a "wave election" like the midterms repeat itself in 2012, Barack Obama would be out and someone like Sarah Palin would be in. The entire Congress would be controlled by Republicans, with no doubt an unhealthy share of Tea Partiers among their ranks. That means the entire reform package could be hanging by a filibuster. With notoriously unreliable Senators like Joe Lieberman (he who slaughtered the public option) shlumping about the corridors of Congress, anything could happen.

The Republicans say they want to replace reform with their own ideas, but have offered extraordinarily tepid suggestions. Their most prominent proposal--allowing insurers to sell policies across state lines--is a bald-faced "gimme" to payers that would allow them to skirt coverage mandates.

Repealing reform in the face of the demographic time bomb ticking in this country is the reckless equivalent of what Ralston did to trap himself: hiking into hostile territory without telling anyone. One-quarter of the population are Baby Boomers, most now entering the vulnerable phase of their careers in their early and mid-50s. Many could get laid off and never hired again. They're not going to bleed $2,000 a month from their already anemic IRA accounts for policies that provide no coverage. They will keep their fingers crossed and tough out a decade or so without insurance until they qualify for Medicare. Should a catastrophic illness strike, they'll tough out three years of disability to qualify for early entry into Medicare.

Hospital and medical group finances are already under great duress, with most experiencing margins of 5 percent or less. That's not going to improve with Boomers going bare and without the additional 30 million Americans reform is projected to insure.

The insurance industry may be too intimidated by their shareholders to look up from their grindstones, but their customer base is also on the threshold of leaving the building. Their products are now priced so prohibitively high that a broad swath of this country will soon no longer purchase them without the tax incentives provided by reform.

So, the Republicans may yet repeal Barack Obama's signature achievement in order to stick their collective tongues out at Democrats. But after the euphoria of toppling reform subsides, most Americans would be left in the rubble--caught between the rock of unaffordable insurance and the hard place of obesity, hypertension, diabetes and other chronic conditions. It would cost at least an arm and a leg to get out, and we might as well slash our own throats in the bargain. - Ron

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