Butterfly Effect in Health Reform

A short piece about Tom Daschle in last week’s National Journal made me think about the importance of the presence, actions, and attitudes of individuals for the direction, success and failure of health reform initiatives.  This is sort of like the “Butterfly Effect” of health policy. [Background:  The “Butterfly Effect” is a thought experiment related to chaos theory, and is based upon the theoretical concept that how a butterfly flaps its wings can dramatically change the weather thousands of miles away.]

Senator Daschle was very qualified to lead the Administration’s efforts on health reform, but several factors led to his removing himself from consideration to be Secretary of HHS.  Since that time, Governor Kathleen Sabelius has been nominated, but not confirmed for that position, and Nancy-Anne Deparles has started as the Director of the White House Office of Health Reform – a position Sen. Daschle was also supposed to hold.  These shifts have caused movement on health reform to be slower than it might have been otherwise.

So, as the “Butterfly Effect” theory indicates, these changes in “starting conditions” will likely lead to different end results. Whether these end results will be better or worse than what might have happened if Senator Daschle had quickly become Sec. of HHS and Director of the White House Office of Health Reform, is hard to know.  But in politics and policy, delays arising from non-substantive issues are generally not a good thing for reaching consensus and making progress.

Battle Over Health Reform
While I don’t think that Sen. Daschle’s tax issues were necessarily a bum rap, I do think he got a bum’s rush out of the jobs for other reasons.  Which is why I was glad to see the National Journal checking in to see what Senator Daschle was up to and what he thought about the progress on health reform.  He stated that he’s been, “very pleasantly surprised so far by most of the important health sectors and the degree to which they continue to be supportive of meaningful health reform.”  He then added, “As long as that environment persists, I think we can stay on the offensive.”

I’m not exactly certain who he means by “we” – it could be the Democrats, the Administration, those who support fundamental reform, etc.  But what caught my eye was  his phraseology “we can stay on the offensive,” which implies that this is a battle or contest of some sort.  That presumption of one side against another may be reason for concern because the Republicans seem to be counting on their ability to polarize as a way to block whatever changes they don’t like.  And if the Democrats adopt a similar stance, then the prospects for health reform legislation to be passed and implemented may be smaller than if both parties don’t engage in a polarizing dance.  [There is also a lesson here from Massachusetts, where comprehensive health reform legislation was twice passed and repealed before actually passing and being implemented into a significant coverage expansion program.  That is, passing legislation is only the first step.  Implementing it takes years, during which time political winds and control of the White House or Congress can change – resulting in dramatically different end results.]

So whether the weather will be favorable for health reform in the next 6-9 months – or just an ill wind blowing – remains to be seen.  But ongoing delays in putting people into substantive positions within the Administration will not diminish the theoretical swirling winds of chaos and the uncertainties about positive outcomes.

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