So the election is over, and the massive barrage of negative ads have ceased, thankfully. What now? Although I am not a soothsayer, and my crystal ball is a little cloudy, a few trends are pretty clear:
1. With the Democrats maintaining control of the Senate and White House, and the Republicans in control of the House of Representatives, we have a fertile ground for continued partisan politics, brinksmanship and gridlock.
2. The re-election of President Obama will likely result in faster implementation of the Affordable Care Act: Think expansion of the number of insured individuals and implementation of health benefit exchanges. In California, we will see an increase in the number of people covered by Medi-Cal (at woefully under-market rates).
3. Given the state of the economy and the increasing slice of the budget spent on health care, it is unlikely we will see a large increase in the amount of money allocated to pay doctors for the expansion health care benefits and coverage provided by the Affordable Care Act.
4. All of the above will lead to more attempts to decrease costs of healthcare: Think more managed care, capitation, bundled payments, ACOs, and other initials and acronyms that will decrease the amount we are paid for our professional services.
5. With more people “covered” by health insurance, albeit with a threadbare sheet of Medi-Cal, there will be increased pressure to expand the scope of practice of non-physician health care practitioners. Think expanded roles for Nurse Practitioners, Physician Assistants, Nurse Anesthetists, and Anesthesiologist Assistants.
In short, we will be asked to deliver more care more efficiently for less money, with practitioners who have less training in medicine and health care delivery.
On a more positive note, of the 100 seats up for election to the California Assembly and Senate in 2012, GASPAC (our political action committee) contributed to 72 candidates, of which 66 were elected. Additionally, virtually all of the candidates elected have voiced support for MICRA, California’s landmark medical malpractice reform, and some opponents of MICRA failed to retain their seats. All contributions and expenditures of GASPAC are available on the Secretary of State website.
Many of the decisions about how we practice and how we are paid for our services will be made at the state and federal government level. This is a wonderful time for you to get to know your legislators and become a member of the CSA Grassroots Network and the ASA Grassroots Network. In this time of change in health care, anesthesiologists have an opportunity to participate in molding new models of care.
Stay tuned to the CSA and ASA websites for more updates to follow, with a particular focus on how this will affect us in particular, as anesthesiologists. There will be many opportunities to get involved in shaping our future.
Together we are stronger!