I loved President Obama’s challenge to the nation and the Congress in his State of the Union last week that we invest in science, innovation, and education to effectively take on the competition of China, India, Brazil, and EU to remain on the cutting edge of leading the future -- e.g. to rise to address our ‘Sputnik moment.' That was leadership and creative thinking.

But what was weird to me was his failure to apparently embrace any of the advice of his Deficit Commission or to suggest how to reduce the national debt before it chokes us out of global competition. He did promise on his part to hold government (civil service) spending flat for 5 years, other than funding his ‘innovation’ challenge.  

I heard between the lines a general indication from both sides of the aisle that increasing reimbursements and fixing the SGR are not likely to be high on the Senate’s or the President’s real list of priorities. It’s hard to paint fixing the SGR as a way to promote innovation -- but indirectly it is in that the profession and the Congress remain hypnotized and constantly preoccupied on the SGR albatross around our necks, rather than on designing new quality-incentivized payment reforms to innovate health care delivery. 

Obama was strong on keeping the Affordable Care Act (ACA) moving (his potential for re-election looking better now than in 2010 means he might have 6 years left to make it work), but he expressed openness to amending the ACA in partnership with Repubs.  He emphasized expanded access, drug funding, insurance reform, and $250 billion in savings. And, he unexpectedly promoted tort reform! That’s great, even though he won’t support caps on non-economic damages. But, we must jump on the opportunity of proposing significant tort reform.

David Cameron is “streamlining” the UK National Health Service budget, and colleagues there know reimbursement will be flat or down; and the Netherlands, Ireland, Spain, and other EU countries are slashing physician payments by over 30%. FFS payment here will be in jeopardy here -- only payment reforms that go after bundled and global population based payment gainshare options seem to be possible routes to ongoing viability.

So, what does this all mean? Well, in summary, my final advice on the implications of the State of the Union and Congress’ current plans is: Gird your loins.