The folks at Perspectives on the Acute Care Continuum asked me to take a stab at some predictions for “things that will matter” in 2013. That’s a bit like asking someone to stroll out on to the center of an iced-over lake to see if the ice is thick enough to support their weight, but I am game considering that it is unlikely anyone will bother looking back at these predictions come the end of the year. I am going to try to stick to issues and events that are likely to impact health care in the coming year, to narrow the scope of the request.
First, let’s get the most important, and most aggravating, question out of the way. What is going to happen to the whole debt crisis thing? I have to say that I was correct in predicting, in my last blog, that we would go over the fiscal cliff – we actually did, even though at the last minute the government grabbed a protruding root that will allow the country to hang on for another two months or so. To boil a lot of political froth down to its essence, this was because the House Republicans who signed the Grover Norquist tax pledge had to wait for the Bush tax cuts to expire for everyone so they only had to cut taxes (for the 98%) rather than raise them (for the 2%). The fact that this pledge cost the Republicans the opportunity to get the entitlement reforms and spending cuts they now deride the ‘deal’ for ignoring seems not to have led to any revision in strategy. No surprise there, but now what?
The Fickle Finger predicts that Obama will use his Constitutional authority to raise the debt ceiling without Congressional approval to save the country (and the world) from the economic turmoil from the threat of US default, which will really anger Republicans and lead to lawsuits and threats to impeach the President.
That still leaves the debt crisis unresolved, but it would clear the way for negotiations on entitlement reform, tax reform, and spending cuts. Unfortunately, it will not eliminate the grandstanding and ineptitude on Capitol Hill, which will escalate in the next two months, and get in the way.
The Fickle Finger predicts that Obama will fail to use the bully pulpit (as the only major politician who will not have to run for office again) to take the lead in proposing the necessary budget cuts and reforms that are desperately needed, and no one in Congress will be willing to take the heat from elderly voters for advocating for the long term solutions required. Thus, the compromise bill will be a pitiful and half-hearted effort that will fail to impress holders of long-term US bonds. The market will briefly shoot up with yet another deal, then begin a long slide to another bottom.
How will this deal affect Medicare?