What does the current economic meltdown mean for health care reform and efforts to control the cost of health care?

Ezekiel Emanuel (oncologist, ethicist and brother of Rahm Emanuel, the Democratic whip in the House of Representatives) has a blog in the New York Times bemoaning the fact that health care reform has “fallen off the radar screen.”  He points out that health care cost increases have been a primary reason why increased productivity has not led to increased wages for most workers, and states that health care “is a severe disease that will have to be cured to get the economy really going.” 

He posted this a few hours before the stock market free fall, when the Dow Jones Industrial Average lost 777 points (and a larger stock index suggested that $1.2 trillion of shareholder value had been erased in a single trading day.) 

 What does this mean to the efforts to reform health care (and control costs)?

 Reasons why we are less likely to see substantial changes in the near future:

1)      1) Health care won’t be the marquee issue of the 2008 presidential election

2)     2)  We have lower expectations for major efforts in health care transformation

3)      3) We will tolerate higher levels of uninsured and underinsured

4)    4)   Government will be distracted  


Reasons why we are more likely to see substantial changes in the near future:

1)      1) The level of financial pain will be high. This makes it more likely that the current trajectory will look unattractive enough that more stakeholders will tolerate more extensive change (and risk).  This isn't all good news -- decreased spending on health care will probably be in both discretionary and truly necessary services. 

2)    2)  Government at all levels is the largest payer, and governmental units (cities, towns, states) are having a hard time balancing their budgets even before we see the full impact of the economic slowdown.

3)     3)  After the financial services deregulatory mess, regulation is “in” again.   This gives government another potential lever to control prices.  In the US, health care cost is generally due to high prices per unit, rather than more units of service delivered than other “first world” countries.  On the other hand, price controls did not work well in the Nixon administration.