pomeroy1As the final speaker at the 2011 UST Executive Conference on the Future of Health Care, former Congressman Earl Pomeroy (D-N.D.) provided a pragmatic, hard-headed assessment of the current state and likely destinations of legislative health care reform. With the Affordable Health Care for America Act working its way through the court system and curtailment or outright repeal looming as possible outcomes of next year’s election cycle, the health care market exists in a climate of uncertainty; Pomeroy’s experience on the Health Subcommittee of the House Ways and Means Committee gives him a unique clarity on where things are and where they’re likely to go.

Pomeroy’s overriding point was that rational legislative debate over health care policy is difficult because the issue is simply too rich in political opportunity for legislators. For a politician, the short-term electoral gain in partisan posturing has nearly always outweighed the benefit of pursuing sound policy acceptable to both parties. As such, Pomeroy said, true movement on health care policy can happen only in two situations: consolidated political control by one party, or such dire emergency that the electoral benefits of posturing are overshadowed.

According to Pomeroy, the Affordable Health Care for America bill began as the product of a moment of consolidated control, but was knocked off the tracks by a confluence of freak political occurrences (particularly the death of Senator Edward Kennedy) and obscure Senate rules, resulting in the passage of a “half-baked” bill that was really meant more as a rough draft (the original intent, according to Pomeroy, was for the final bill to more closely resemble the version that passed the House, but maneuvering around a Republican filibuster prevented this). This, he feels, explains the bill’s many shortcomings, including the delayed implementation of many of its key provisions.

Pomeroy said that a Supreme Court decision completely overturning the bill is possible, but probably not likely; even if portions are overturned, he feels that the bulk will likely pass judicial review.  Further uncertainty exists in the shadow of the 2012 elections;  Pomeroy suggested the chance exists that Republicans will gain control of the Presidency and both houses of Congress (and he notes that Republican rhetoric has slowly shifted from “repeal and replace” to just “repeal”), but that even then the nature of the Senate means that Democrats would be able to filibuster attempts at repeal. Moreover, Pomeroy views a second Obama term as essentially a 50-50 proposition.

In other words, something resembling the current divided-government stalemate is likely to persist. The “hope” for clarity in health care legislation, then, lies in Pomeroy’s second condition, that of a crisis large enough to override short-term political considerations. Describing politics as “the ugly monkey on the back of health care policy,” the former Congressman believes that a combination of the inadequacies of the Affordable Health Care for America bill, the lack of a political climate conducive to fine-tuning these inadequacies, and the trendlines of American health care expense will almost certainly lead to a situation in which true health care reform is unavoidable. Which sounds a bit apocalyptic, but Pomeroy remained upbeat and confident that, however ugly the process, Washington would eventually do its part to create a healthy environment for health care innovation.