The Congressional $700 billion fix of the Wall Street banking and credit mess might have stabilized our 401(k)s for awhile, but doesn’t leave much on the table for health care next year. Note that the SGR “fix” would add over $300 Billion to the national debt (China would likely need to loan us that, so we docs would all be working for Beijing, I guess). But, as I reported last week, major leaders in the House and Senate still believe major reforms will proceed in 2009.

Senator Kennedy weighed in on this late last week, even though he’s running his office from home in Massachusetts. His chief health reform strategist, John McDonough, told ACC this week that their reform idea would include:

• Coverage (universal or near universal coverage)
• System reform (comparative effectiveness, primary care medical home, HIT, payment reform, transparency, prevention, disparities, workforce, etc)
• Financing that doesn’t add further to the deficit (which, to me, means cuts somewhere else).

Obama plans to apply his reversal of Bush tax cuts on the over $250,000/year crowd to finance some expansion of coverage on kids. McCain will give every family a $5,000 tax credit voucher to purchase their own coverage (which offers the advantage of more choice and portability). But, he would finance those vouchers by taxing as income all employer coverage, which is now tax free to employees. With family premiums at about $13,000 a year, that would add thousands of dollars of new taxes for those who elect to continue their employer coverage. Both McCain and Obama plan to try to lower average insurance costs with better group purchasing (free market at work?), and, for Obama, with insurance reforms as well. Kennedy hasn’t said where he’d recommend getting the $$$. But, I don’t think this will be easy for any of them. [For more coverage see today's Health Affairs blog, which summed up its coverage of the candidates plans.]

The ‘free, largely unregulated market’ idea, which will be changing for Wall Street of necessity, has existed in health care much more for health insurers and industry (who more often set their own prices) than it has for doctors and hospitals (where we are largely at the mercy of what government and insurers pay). We might benefit if there was a more level playing field among all the health care constituencies, where right now we are at a distinct disadvantage to insurers, industry, and hospitals. But, there are some very bullish forces at work out there in the economy that will definitely affect health care. Need to be on our toes here…