Most pundits have been describing last week's elections as a victory for the status quo, with President Obama being reelected and Democrats retaining control of the Senate despite the timid economic recovery and despite SuperPACs spending nearly a billion dollars on largely negative campaign ads. From a health and science policy perspective, however, nothing could be further from the truth.
For example, As House Speaker John Boehner correctly stated in an interview with Diane Sawyer, for example, the Affordable Care Act -- also known pejoratively as Obamacare, a term the President now embraces -- has become "the law of the land". Republicans in the US House of Representatives will undoubtedly continue their efforts to repeal the more contentious parts of that Act, but the Senate and the President's veto pen will prevent that. This means that, starting in 2014 all US citizens and residents will be required to have some form of health insurance. Moreover, insurance companies will no longer be able to deny coverage to those with preexisting conditions.
Efforts to overturn Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion in the US, will also be slowed. So too will efforts to defund Planned Parenthood and to pass legislation allowing employers to deny women birth control coverage. The resounding defeat of Senatorial candidates Todd Akin and Richard Mourdock after they both made controversial comments about abortion and rape demonstrate the GOP's growing gender gap. That same gap also contributed to the President's reelection, with the Obama carrying key battleground states primarily because women voted for him overwhelmingly.
Conservatives can chalk up one health policy win, however. Voters in Massachusetts rejected Question 2, which would have legalized physician-assisted suicide in the Bay State. Despite pre-election polls suggesting that the so-called "Death with Dignity" initiative would pass, it was narrowly defeated in one of the country's most progressive states. A stunning setback for the assisted suicide movement, this leaves Oregon and Washington (and maybe Montana) as the only states in which a terminally ill patient can seek a physician's aid in ending their own life.
Voters in Massachusetts did legalize medical use of marijuana, making it the 18th state to do so since California first did so in 1996. Voters in Colorado and Washington took the war on drugs a step further by passing ballot initiatives that would legalize its recreational use. The federal government still considers the distribution or possession of marijuana to be a federal crime, occasionally cracking down on medical marijuana sellers. Last year alone, the federal Drug Enforcement Agency raided and closed nearly 600 marijuana dispensaries. But that too may soon change.
According to Washington insiders, President Obama considers the War on Drugs to be an abject failure. Over the past two decades, billions of dollars have been spent combating drug use. But victories in the War on Drugs have been few and far between, and continued and growing demand for drugs like marijuana fuels a global market largely controlled by organized crime syndicates. Some studies suggest that legalizing recreational use of relatively benign drugs like marijuana could combat this, with key drug traffickers like Mexico's notorious Sinaola cartel loosing more than half of their annual income. In fact, the arguments in favor of legalizing a drug like marijuana are pretty persuasive. By comparison, opponents of legalized marijuana come across as clueless as Mr. Mackey, the fictional school counselor of the hit show South Park. His only argument: "Drugs are bad, m'kay?" While I doubt the Obama Administration will push for legalization of drugs like marijuana, I think that it is likely that the Feds will spend a lot less time cracking down on medical use of the drug than they have in the past.
While last week's election could be seen as a kind of political mulligan, likely leading to four more years of gridlock in DC, one thing is clear: health care reform is here to stay. The Affordable Care Act will be fully implemented in 2014 despite conservative opposition. Furthermore, the War on Women and the War on Drugs have also been dealt severe blows. Given the multitude of problems that face the country, from the looming "fiscal cliff" to uncomfortably high levels of unemployment, we can only hope that our leaders in Washington finally put 'death panels' and Medicare cuts behind them and focus on real bipartisan change.
A public health researcher and ethicist by training, Dr. Sean Philpott is a professor of bioethics at Union Graduate College in Schenectady, New York. He is also the Chair of the US Environmental Protection Agency’s Human Studies Review Board, which reviews all research involving human participants submitted to the EPA for regulatory purposes.
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