Election 2008: 5 Quick Observations

1. It's clearly an historic moment in the United States when we have elected an African American president for the first time. Whether Republican or Democratic, we all can be proud and excited about this milestone. Moreover, I've known Barack since law school, and he is both a remarkable person and a very, very good person.  He may lean left politically, but he has a great sense of not overplaying his hand. Except for those who desire him to fail so as to recover the White House, I think this will make many on the Republican side more comfortable over time. In the end, we strongly prefer a balance of power between Congress and the White House. If we don't have the balance of power I am glad that the Republicans retained more Senate seats than expected and my hope is that Barack Obama will not make wealth redistribution and other items that discourage business growth a core part of the next four-year plan.

2. The real story underreported thus far is the lack of pickups the Democrats had in the House and Senate. Many predicted pickups would result in 60-plus Democratic seats in the Senate, and a pickup of 25 or more in the House. The popular vote ended up faily close (6 percent or so) and the net pickups were not as big as expected. Hence long-term, one-party rule is not the certainty some have been saying. The Republican Party must come forward and stand for something such as fiscal care, which it missed the last few years. That stated, it remains very much a two-party system. What is somewhat remarkable is, given the choice of Palin and the financial blowout over the last 45 days, how close it really was. 

3. On healthcare, I think you will see a movement to something akin to the Massachusetts plan — all required to have coverage —but not a single payor system, a horrible system for all. Thank goodness.

4. On self-referral, I do have concern that, in the noise of all other aspects of policy over the next few years, the axis of Stark, Grassley and Baucus will have more power to harm physician-ownership of hospitals. I assume President Obama will sit down with this axis without preconditions.  I believe, given the number of ASCs and the 35 percent discount on services that ASCs provide the government, that ASCs are far, far better-positioned than physician-owned hospitals.

5. Entrepreneur-driven healthcare will see not death but a tremendous reemergence over the next few years. Also, it is likely that existing physician-owned hospitals will continue to thrive.

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