With the Democrats losing their 60th vote in the Senate in Tuesday’s special election, the political and health policy worlds are astir with angst about the fate of health reform legislation.  Everyone in those arenas has at least one perspective about what would be the best course of action… including MoveOn, which stated in an email today, “Tuesday’s election was a shock. But the aftermath was even worse:  President Obama and some Democrats in Congress are now considering scaling back health care reform. That would be a huge mistake.”

However, given that MoveOn was one of the leading organizations declaring that the public option was the most important part of health reform, I’m not too inclined to put much stock in their understanding of the fundamental policy or political forces in the US right now.

Despite MoveOn’s proclamations, it seems clear that health legislation in 2010 will be smaller than either the House or Senate bills.  Whether that occurs in a bipartisan way (unlikely), via reconciliation (more likely, but limiting the scope of the bill), or through some other mechanism, remains to be determined by the political officials looking toward the 2010 elections – with perhaps some input from policy people. In addition, it is likely that HHS (and possibly some states) will get much more active with demonstrations and pilot programs, and the Federal government may look to the investments in Health IT and Comparative Effectiveness Research made in last year’s stimulus law as more fundamental cornerstones to build from.

Regardless of what comes next, some rock and roll lyrics seem very prescient for what has happened with the health reform legislation:

Sometimes the lights all shinin on me;
Other times I can barely see.
Lately it occurs to me what a long, strange trip it’s been.

But still they lead me back
To the long winding road.

You can’t always get what you want
But if you try sometimes you might find
You get what you need.

These images may also be illuminating for the path ahead, and are consistent with some of my predictions:  A year ago I wrote about the long and convoluted path health reform legislation would likely travel. And in a post last June I stated that many factors could change the course of the legislative process.

“Being prepared is important for the success of health reform as the debate intensifies this month, because there are many, many things that could influence the outcomes.  Some of these factors are intrinsic to healthcare and the legislation – such as how to pay for health reform – while others are extrinsic to healthcare and the specific legislation.  (I’ve made a list of the extrinsic derailing possibilities, but it is too long to include here.)

“What contingency planning means for health reform is that not only does there need to be a multi-year implementation plan for the specific provisions of any new health reform law, but there also needs to be preparation for the unexpected – but inevitable – hurdles that will get thrown into the path of the development and passage of any legislation.”

So, as always, keep your seat belt fastened and the tray tables in their upright and locked position.