Obama wins. Now what?

Most pollsters have Obama well ahead nationally and in the swing states, with Gallup reporting he has almost reached a double-digit lead.. And after last night's debate, which Obama 'won' handily more independents look to be behind his campaign (although if you watched the alternate-universe-dwelling wingnuts on Fox, you might not get that impression).
It is looking very good for Obama, and very bad for the Mav (the bettorshave it Obama with a 73% chance of winning).

So, the Senator from Illinois wins. What does that mean for health care?
We've established that his big reform plan is not going to happen. And I couldn't really take Obama at his word when he said last night that health reform would be his second priority after energy. Energy's big, but health care is bigger.

Here's what I'd expect we'll see in 2009-2010 from Congress and the new President.

Expect the new political year to begin with incremental fixes to specific programs - The biggie will likely be Medicare physician compensation. With docs scheduled to see their reimbursement drop by around 20% in 2009, the caterwauling will be heard loud and clear inside the Beltway. Don't look for a major policy change, but rather something to satisfy the physician community and build a little equity for the future. Where will the money come from?

Do not be surprised if CMS is expressly ordered to negotiate prices with big pharma in the near future. The Part D program is a budget buster, big pharma has few political allies (despite big contributions) and reducing the cost of drugs will save CMS budget dollars that can be spent on physicians.

SCHIP may be next out of the blocks. The expansion of coverage for kids is a central piece of Obama's platform on health reform, and with a Democratic Congress the chances of meaningful expansion of this program are pretty good. And it won't just be Democrats voting 'aye'. After the back and forth battles, marked by confusion and consternation from Republicans who felt Pres. Bush threw them under the bus by vetoing a bi-partisan bill to extend SCHIP earlier this year, enough Republicans are likely to cross the aisle to support funding of a somewhat-expanded program.

Also on the table will be reduced funding for Medicare Advantage, a program that has long struck Democrats as a giveaway to big healthplans. Foolishly. the insurance industry worked hard, and effectively, to block reductions in MA this year. As Bob Laszewski notes, with Congress and the White House changing hands, the bill they stopped this year will look great compared to what they'll get next. Expect MA subsidies to be slashed, in what could, and should, be seen as a shot across the bow of the insurance industry.

The FDA will also be under the microscope. Despite passage of the Food and Drug Administration Amendments Act of 2007, ostensibly fully funding the FDA and giving it the staff needed to do its job, the FDA continues to stumble. With a Democrat running the Administration, expect increasing oversight, much more post-approval monitoring, and much less tolerance for patent-extending gamesmanship.

What does this mean for you?

Obama is a very smart guy who knows enough to not try to do everything at once. Incremental steps mean progress towards reform - and are easier to accomplish, build consensus. momentum and working partnerships.

Joseph Paduda