After gaining control of Congress, Democrats have vowed to make health care a priority for the next two years. In your opinion, what health care legislation (if any) is most likely to pass Congress during that time? What are the most important health care reforms that are least likely to be considered and why?

John R. Graham
Director of Health Care Studies, Pacific Research Institute

The Democrats have to do little to ensure that the U.S. drifts into a government-monopoly health care system.

Besides legislation to give the government power to directly control prices in the Medicare drug benefit, which will surely be vetoed, they will reauthorize SCHIP and throw more money at both it and Medicaid. As these programs continue to crowd out private health care, and more Americans age into an unreformed Medicare, individual choice will wither away.

The inexcusable failure of the President's HSA agenda during the Republican Congressional majority means that consumer-directed health care risks losing momentum.

David Gratzer
Senior Fellow, Manhattan Institute Center for Medical Progress

During the campaign, Democrats promised to take an ill-conceived entitlement (Medicare Part D) and make it worse. And, with their eyes on 2008, they are likely to offer Americans the 3 R's of health policy: Reimportation—bringing prescription drugs from Canada, at Canadian prices; Recertification—renewal of SCHIP, a perfect opportunity for Democrats to push for expansion; Reinsurance -- whereby Washington would cover large employee health bills, not employers.

Republicans are unlikely to support these ideas; I see two years of gridlock. Some may say that I'm pessimistic. ...Actually, I'm a libertarian and think this the best outcome under the circumstances.

Paul Howard
Senior Fellow, Manhattan Institute Center for Medical Progress

Much may seem to have changed in Congress in the past month, but when it comes to health care, appearances are deceiving. With presidential elections looming, neither party has an appetite for sweeping health care changes.

Congressional hearings and incremental initiatives will be the order of the day—and although votes may come on drug importation, drug price negotiations for the Medicare drug benefit, and expansion of SCHIP for low–income children, two of these measures, on importation and drug price negotiations, are bound to attract a presidential veto. SCHIP may pass, along with legislation providing additional funding for health care IT infrastructure, which both parties favor.

The most significant potential storm on the horizon is the reauthorization of the Prescription Drug User Fee Act (PDUFA), which authorizes the FDA to charge user fees, currently over $800,000, for the agency to process new drug applications from industry sponsors.

Congressional hearings on PDUFA reauthorization will begin next year, and legislation must be passed and signed into law before the current PDUFA mandate expires at the end of September 2007. These hearings are apt to be contentious, with industry critics advocating onerous new safety regulations and advertising restrictions. PDUFA funds are critical for the operation of the FDA's drug review process, and the President will be under intense pressure to sign, rather than veto, legislation that reaches his desk.

Peter Pitts
President, Center for Medicine in the Public Interest:

Post–election it's all about the letter "P." We will lose whatever momentum there was towards an FDA focusing on (as Andy von Eschenbach phrased it) "the three P's of prevention, predictive tools, and the participatory Critical Path." We will move to a Congress focused on payback and partisan politics. And that means lots and lots of hearings couched in the word "oversight." And that's particularly dangerous right now because of PDUFA. There will be debate over Part D, specifically over revoking the non-interference clause. Pelosi has this on her "First 100 Hours" to-do list.

And that's just a preliminary peroration towards a more frightening parley over price controls and intellectual property (aka: patents). Those first 100 hours are beginning to sound like a real Reign of Terror for Big Pharma. Does anyone really believe that government can negotiate better than private industry–for anything? One need only look at the negotiated VA system which offers 1300 drugs on its formulary vs. 4300 for the average Part D plan. America's health is too important to be about partisanship or profits. It must be about progress and patients.

Benjamin Zycher
Senior Fellow, Manhattan Institute Center for Medical Progress

Big Government is far more efficient at mischief than mitzvah (loosely, good deeds), and so the wisdom of the Founding Fathers becomes clear: The general difficulty of getting things through the Congress is a blessing. We are unlikely to see actually enacted into law the more egregious examples of creeping health-care socialism loudly suggested by some. No national ("single-payer") health insurance. No monopolized federal "negotiations" for drug prices—better described as price controls—under Medicare Part D. No additional constraints on the growth of health saving accounts, a lonely policy attempt to reintroduce market incentives with respect to health care decisions.

Nor are we likely to see favorable policy shifts. No increase in Medicare and Medicaid co-payments, that is, efforts to discipline the consumption of health care. No change in the tax subsidy for gold-plated employer-provided health insurance. No legislation to engender a national market for health insurance by allowing consumers to purchase policies from out of state. But we will see an expansion of the number of people "covered," that is, who can consume health care without bearing the attendant costs. And so the can will be kicked down the road: Real reform will await courage from the next group of policymakers even as the underlying problem metastasizes and grows more resistant to change.