Sayonara

to weird sicko (or sick weirdo) Rick Santorum, who will now be able to devote full time to worshipping his pickled fetus. Adios as well to Bill Frist, who can give up his schtick as Karnak, the Magnificent Psychic Diagnostician and go back to defrauding the taxpayers through his family business at Hospital Corporation of America. And to many a wackjob, thief and liar. So long, goodbye, don't stand in the doorway letting the cold air in.

Unfortunately, there are quite a few of these rabble left in the Congress, from Brownback to Inhoffe to go, Virgil go, Virgil B. Goode. So as health policy reporter John Iglehart predicts in the new NEJM, we probably should not expect anything dramatic in the health care reform department for the next couple of years.

As Iglehart points out, the Democrats' promise to institute "pay as you go" rules for any new spending, along with the availability of the filibuster to Senate Republicans and the veto pen to the White House occupant, sharply limit the possibilities for significant expansion of health insurance coverage. Expanded federal funding of stem cell research may pass the Congress, but will probably hit the veto wall. Allowing Medicare to negotiate with drug companies for lower prices might pass, but that doesn't mean the administration will actually have to do it.

A few days ago I posted about the overpayments to so-called Medicare Advantage plans. These are the Republicans' pet scheme to save Medicare dollars, but of course they have the opposite effect, lining the pockets of private insurers at your expense. Iglehart doesn't seem to have an opinion on whether Congress will do anything about this. Given that Big Insurance has been moving to hire Democratic lobbyists and will no doubt be dangling campaign contributions in front of the new majority party, I'm not holding my breath.

As for expanding health insurance coverage, Iglehart thinks the "Blue Dog" Dems -- who are strongly committed to balancing the budget -- will probably stop anything major from happening.

As with the expecation of most observers about the occupation of Iraq, which the Democrats have pre-emptively pledged not to defund,* Iglehart expects the most excitement to come out of oversight hearings. He expects new FDA Commissioner Andrew von Eschenbach to spend a good deal of his time on the hot seat before various congressional committees. I would add that Medicare, CDC and other HHS programs may be in for a good, hot roasting. What all this will ultimately mean for public policy, however, is not so clear. I'm afraid that our long national nightmare will not be over for at least a couple of years, although we may at least be emerging into lucid dreaming and the hypnogogic state.

*The standard Democratic negotiating position starts with, "You can have everything you want. Just please don't be mean to us."