Dean, professors weigh in on Supreme Court’s ruling on health care reform

The Supreme Court upheld President Barack Obama’s health care reform law on Thursday.

In anticipation of the announcement, we asked several of our professors to offer insight on the subject. Members of the media wishing to interview these professors over the telephone may call John Morgan, associate vice president for public relations, at 203-206-4449.

Here is what they said:

Bruce Koeppen, founding dean of The Frank H. Netter MD School of Medicine:

Not being a lawyer I cannot comment on the legal merits of the decision.

However, whether we have the Patient Protection and Affordability Act (PPAA) or not, this country is headed for a health care crisis.  Whether individuals have insurance or not, we are reaching a point where access to services will not be available, simply because we have too few providers.

Consider the baby boomers.  Eighty million will be entering Medicare.  Greater than half are already diagnosed with a chronic disease (e.g., hypertension, diabetes, hyperlipidemia, etc.)

They also have a history of more elective medical care.  Thirty percent of the current physician workforce plans on retiring in the next 10 years.  These are the 24/7 practitioners who are being replaced by younger physicians who “want a life” in addition to medicine (i.e., practice part-time.)  If you add to this the uninsured who could be added to the system though the PPAA, we reach crisis stage faster.

I believe access will be such an issue that the public will demand that states open up practice acts, and let non-physician health care providers provide some basic services independently of physicians (two-tiered health care system?) That process will be a bloody turf battle.

Every physician I know believes everyone should have access to quality medical care, and they also believe providers should be paid fairly for the delivery of those services. I have seen no logical plan to bend the cost curve, and I am not optimistic that the PPAA will even do that.

Sorry to seem negative, but I believe this is the sad reality.

Angela Mattie
, associate professor of management in the School of Business and a health care lawyer:

A main pillar of the Patient Protection and Affordability Act (PPAA) is to expand coverage to the significant amount of Americans who currently lack insurance coverage.

This is only possible by expanding the risk pool in order to spread the risk and cost of providing this care.   In other words, for successful implementation of this policy, all Americans need to have some form of minimal health insurance coverage.   If the constitutional challenge is upheld, it would be nearly impossible to expand insurance coverage as intended in PPAA.

By most accounts, it is likely this constitutional challenge will be struck down and ends as an interesting bump in the road to implementation of the Patient Protection and Affordability Act.

The danger lies, however, in assuming that the road for better health care quality should end with the implementation of this act.

This act does much in expanding healthcare coverage and limiting exclusions for those individuals with pre-existing conditions.  However, much more is required to improve the quality and cost of our health care system.    This is one road on a major highway that must be traveled.

John Thomas
, professor of law who specializes in law and medicine:

On the policy merits:  I believe that the ACA’s mandate to purchase health insurance is necessary not only to provide health care to the uninsured, but is the nation’s only hope for control rising health care costs.

Without mandating that the healthy purchase insurance, we will inevitably enter what is known in insurance policy as “the death spiral”:  Only the unhealthy will purchase insurance, producing an insurance pool that is very expensive to cover, which in turn will lead to increase premium costs, which will lead other healthy individuals to forgo purchasing health insurance.

On the constitutional claim regarding Congressional power to mandate the purchase of health insurance: It is clear that the founders of the Constitution believed that Congress had this very power.  The very first Congress in 1790 enacted legislation requiring that ship owners provide health insurance for seamen.

In 1798, Congress enacted related legislation requiring seamen to purchase hospitalization insurance.  As for the broader “broccoli” question, in 1792, Congress enacted legislation requiring that all able-bodied members of the citizenry acquire a firearm.

Categories: Frank H Netter MD School of Medicine, News, School of Health Sciences, School of Law

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