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On the Third Hand: What won't change

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The truth is that all I really want to do today (Monday, Nov. 5, one week After the Storm) is consume other reporters’ media and search Twitter until I feel as if I understand what’s really happening on Staten Island and the Jersey Shore. Can the situation really be THAT bad? Why are they taking so long to let people look at the wreckage of their homes? Is it true that search crews are still finding bodies in some areas?

But life lurches on. There’s an election tomorrow; I have to remember it and make myself go vote. My polling place in Jersey City is very luxurious. It has heat, electricity from a power line (as opposed to a generator!) and, as far as I know, no evacuees sleeping in it. (At least, not officially.) 

It hit me today that I somehow turned my company-provided Twitter feed, at LHPro_Health, into a feeble Hoboken and Jersey City storm commentary and consumer information service. Somehow, I have to shift away from trying to tell people that discount stores in Jersey City actually have AA and AAA batteries, and working ATM machines, to using it for the intended purpose and tweeting about health insurance and related topics.

Chances are that tens, maybe hundreds, of thousands of people in the Northeast will go the polls tomorrow, marvel briefly at the presence of heat and electric lights (and, if they use the restroom in the church: hot water coming out of the faucets!!!), then go into voting booths and stare blankly at the voting machines as we try to remember what an Obama is, what a Romney is, and why we might take an interest in who senators are.

On Wednesday, we’ll try to cover the implications of what the election results will mean for health care.

If you’re reading this very late Tuesday, or later, you already know a lot more than I know right now about who will be in the White House and who will control the office space in the House and the Senate.

It hit me that, for the U.S. health finance system, the results won’t really mean that much.

The results might be helpful or annoying for health insurance agents. At least the Romney people wouldn’t act so snotty about the idea that someone who’s out to make a profit might be a good, helpful, caring person. But Romney says on his website that he, too, likes the concept of health insurance exchanges, even if he hates Obama’s exchanges. He, too, would (will, if you’re reading this and he’s won) probably help insurers and consumers put the screws to producers.

And, really: When are folks not  trying to put the screws to producers? Producers continue to survive because they’re clever, nimble and indispensable, not because anyone ever wants to pay them.

If Romney wins, or something dramatic happens (has happened?) in the Senate, the folks in Washington could throw a few thousand pages of documents canceling the Patient Protection and Affordable Care Act (PPACA) at health insurers.

The same thing could actually happen even if Obama wins, Democrats still control the Senate, and the Democrats who end up controlling the Senate aren’t as keen on PPACA as they used to be. But, really: health insurers already have been betting on the idea that they’ll be selling a lot of private coverage to people in Medicare and Medicaid plans.

It seems as if Romney’s health care proposals, and proposals for giving more responsibility to the states, would probably lead to health insurers selling a lot more coverage to people in Medicaid and Medicare plans. All roads seem to lead to more of the U.S. health care system looking more like the Medicare Advantage program.

Romney would be warmer to health savings accounts (HSAs) and health reimbursement arrangements, but even the Obama folks seem to understand that they can’t slap HSAs in public. They’ve waited until they’ve been alone in small, dark regulatory closets somewhere to thump HSAs on the kidneys. HSAs may be bruised, but they’re still here. They’d just be here more cheerfully and confidently under President Romney.

And conditions like diabetes and heart disease still ruin the lives of far more people than any hurricane. Sandy flooded hundreds of of thousands of basements Oct. 29; chronic disease warps the lives of tens of millions of people every day of the year.

Property-casualty insurers might have to pay, roughly, $10 billion to $20 billion to cover the insured losses caused by Sandy. Health insurers spend something like that just on covering normal childbirth.

On the one hand, Obama would try to scoop out a little of the oceans of health care cost sludge in our national basement now. Romney would postpone making the big decisions by giving the job back to the states and telling them to go through their own vicious health finance mixed martial arts duels to the death. Insurers and states would have to scrap a lot of expensive work they’ve already done.

On the other hand, the cost of efforts to create exchanges and new regulatory regimes pales in comparison with the total cost of health care and health insurance, and Obama has also postponed making plenty of decisions about who will have to pay how much to reorganize our health care system. 

On the third hand, no matter who wins (or, has won), we still have to figure out how much we’ll really balance the books by sticking it to patients, doctors, hospitals, other providers, manufacturers, producers and insurance companies — or accept the reality that we’ve stuck it to someone by refusing to make conscious decisions about allocation of pain.

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