Meaningful health reform is dead

Any question about whether comprehensive health reform is still possible in 2010 ended Wednesday night when President Obama buried the topic in his State of the Union.

His former number one domestic item (health reform) followed more than a half-hour on jobs (his new number one domestic item), bank reform, and energy policy. And what the president actually said about health reform was limited and didn’t shed any more light on what kind of reform he actually expects now.

Sure, Obama mentioned the need for health reform and that Congress is close to accomplishing the work. But he didn’t do what was needed. I wrote on this blog yesterday that the president needed to:

• Spark the Democratic leaders to action
• Provide a roadmap of his top health reform provisions
• Suggest whether to continue with a vast health reform package or target specific smaller projects, such as payment reform, additional insurance regulations, pilot projects, and expanding Medicaid and state Children’s Insurance Plans
• Offer an olive branch to Republicans

He accomplished none of those.

So, where are we now? I feel even less confident that meaningful health reform is possible in 2010. Instead, I expect piecemeal reform that attempts to tackle issues, such as added health insurance regulation, subsidies for small businesses to provide health insurance, Medicare/Medicaid/state Children’s Insurance Plans’ expansion, pilots projects, and minor attempts at payment reform.

These small attempts at reform will provide insurance to a small number of the 47 million uninsured while adding some protections for those with pre-existing conditions. The reform will not affect other important issues though, such as spiraling costs and quality.

Congress and Obama had an opportunity to bring about health system improvements, but that no longer seems possible this year. Meaningful health reform in 2010 is a goner.