Editor's Note

Whither Reform?

Congress’s lengthy and painful debate leaves providers guessing.

• By David Kopf
• Jan 01, 2010

The more I think about it, the more I’m convinced that I’d be a happier person if I were a pessimist. That way, I’d have my expectations perpetually managed. I’d expect the worst from everything and everybody, and would be pleasantly surprised when things actually did work out. They say ignorance is bliss, but I’ll bet you a barrel full of dashed hopes and dreams that a negativeoutlook will get you there quicker.

I’m came to this conclusion after watching the Obama administration’s and Congress’s regularly televised agonizing over healthcare reform. When I think of how healthcare reform looked as Obama took office, versus how it looks now, I have to say I’m pretty stunned both from the standpoint of a taxpayer and a member of the HME industry.

Call me naïve, but things were looking pretty good during healthcare reform’s early days: Former Senate Majority Leader Tom Daschle had been nominated as HHS Secretary and the head of a newly created White House Office of Healthcare Reform that would drive a fairly well outlined set of reform goals through a Democrat-laden legislature. Both Daschle and Obama made several references to the necessity of home health as part the reforms.

But things went South real quick. Daschle withdrew his nomination over his failure to some back income pay taxes. He paid the back taxes, but he still stepped down, and was replaced by Governor of Kansas Kathleen Sebelius. In terms of leadership, Sebelius has been ethereal: there is but a hint that she is involved in the process at all, and while healthcare reform has become a regular topic of household discussion, her name certainly has not.

Sebelius’s non existence, along with a President also addressing the nation’s sour economy and twin military involvements, has give reform’s opponents — particularly those opposed to a public option — free reign to dominate the debate over healthcare. And the debate has been anything but nuanced. (I’m pretty sure that toting an assault rifle over your shoulder at a Presidential “town hall” meeting qualifies as an “obtuse” argument, but I’ll give it points as an imaginative wardrobe accessory.)

But the public debate has been tame compared to the legislative debate — and this is where the homecare industry could feel considerable pain. In our hallowed halls of Congress, House and Senate lawmakers have attached an array of provisions to various healthcare reform bills that are aimed (much like an assault rifle) squarely at the HME industry. These include provisions for removing the firstmonth purchase option on power mobility, further cuts to oxygen providers, expansion of competitive bidding, and even excise taxes on manufacturers of DME. It’s as though they actually think an industry comprising less than 2 percent of Medicare’s budget can solve all of healthcare’s problems.

And the debate has been agonizing, as well. They say watching lawmaking is akin to watching sausages being made, but I think I’d compare it to watching paint dry (or better yet, sausages dry). This is especially true with the Senate debate, which has seen Senate Republicans and Independent Sen. Joe Lieberman (I-Conn.) drag out the debate in order to force Democrat compromises, and possibly drain whatever reform is left in the legislation in order to give the administration a check in the “loss” column. Net-net, we are no closer to health reform as we publish this issue of HME Business than we were when we started it, and the debate will rage (or drag) on into 2010.

This is why we included healthcare reform as a key trend that providers should monitor in the New Year as part of our third annual Big Ten list (page 14), which lists 10 important industry developments that will impact your business in 2010. Knowing them in advance might help you adapt to the changes this New Year has to offer, and that might be a point where you can enjoy some safely guarded optimism, after all.

This article originally appeared in the January 2010 issue of HME Business.