You might not be on pins and needles awaiting the Supreme Court ruling on the Accountable Care Act, what with all the priorities already on your daily to-do list. Still, the anticipation in the health care community is palpable. The decision could come down any time now, though most D.C. types say it'll probably be in the last week of this month. Whenever it happens, H&HN Daily will send out an email alert with immediate reaction, whether the high court upholds the law in its entirety, strikes it down altogether, or lets certain elements stand and rules other parts unconstitutional.

 

In the meantime, I thought I'd share excerpts from several reports about the ACA and the health reform effort in general that I've collected from a variety of media outlets since the beginning of this year. They're certainly thought-provoking even if you don't agree with every point they make.

Darshak Sanghavi, writing in Slate Magazine on Jan. 31, noted that nationally there is "a fundamental disagreement over the nature of health insurance. Should it be 'social' insurance, with which financial risk is leveled between those who are ill and healthy, so the carefree twentysomething and diabetic elderly man pay equally into the system? Or would it be better structured as 'actuarial' insurance, where those expected to consume more shell out more?"

Sanghavi contends that "Americans made their choice long before Barack Obama ever signed the law — and they picked social insurance. The issue today isn't whether we should redistribute health care dollars. We do, arguably to the same degree every other country does. Nations with national health insurance systems explicitly redistribute money before patients get in car accidents, discover cancer or develop heart disease. Here we do it in secret after illness occurs. We create the illusion of actuarial insurance, when the truth is that all major American health institutions have been socialized for decades."

Jennifer Granholm wrote in Politico Pro on April 3 about a conversation she had with her hairdresser, who couldn't afford health insurance and was still trying to pay off a $3,000 bill accrued when she came down with so-called walking pneumonia. "Of course, I'd have health insurance if I could afford it. Anybody would," the woman told Granholm, who went on, "And then she said something that turned the 'individual health care mandate' opponents' argument on its head: 'I'm already forced to buy health care — but it's in the emergency room. It's almost bankrupting me. Do these guys think that's my choice?'" In other words, Granholm wrote, "She was forced, mandated, to purchase emergency care or choose to risk her life."

In a May 22 interview in the New York Times, Dana Goldman director of the Schaeffer Center for Health Policy and Economics at the University of Southern California and founding editor of the Forum for Health Economics and Policy, discussed the benefits of shifting health care's emphasis from treatment to prevention: "It is not pie in the sky. If we reimbursed on the basis of preventing disease rather than treating it, the world would be different. With obesity, for example, you could imagine a much more concerted effort not only for diet and exercise, but also for biomedicine. A pill to prevent obesity would be worth literally trillions of dollars."

In a June 7 Washington Post blog, Ezra Klein considered whether President Obama was wrong to put so much effort into health care reform, noting, "Another popular idea is Obama should have taken a moment to focus on long-term deficit reduction. Of course, as far as Obama is concerned, that's exactly what he did" by addressing what the president has called "the crushing cost of health care."

 

"And all this has to be balanced against the fact that health reform was, legislatively, a success, and the nation is certainly closer than it's ever been in its history to extending insurance to every American," Klein wrote. "If the bill survives for the next few years and goes into effect in 2014, my hunch is it will be remembered as the signal triumph of Obama's presidency, not a key mistake. If it's repealed or overturned, then, of course, history's judgment will be different."

 

In his June 5 New Yorker blog, "The Real Stakes in the Health-Care Case: A Guide," Jeffrey Toobin concluded, "In the election of 2008, the party of smaller government lost at the polls, but the Supreme Court may yet trump the will of the voters. It's happened before."

And if that does come to pass? "Make no mistake — regardless of what the justices decide, or whether the mandate requiring everyone to buy health insurance stands — health care is already being changed in significant and irreversible ways," Steve Twedt wrote in the Pittsburgh Post-Gazette on June 10. He pointed out that hospitals "are under increasing pressure to care for more patients on an outpatient or 'observation' basis, to provide care more efficiently to limit complications and readmissions — and to do it all at lower costs."

A.J. Harper, president of the Hospital Council of Western Pennsylvania, expressed the opinion of many health care leaders around the nation when he told Twedt, "If [the law is] shot down, or if some of it is recrafted, we believe those components on cost and quality are going to stay." Hospitals, Harper said, "are not going to change their strategies or pull back because of the [Supreme Court's] decision."

And in the wake of announcements by several major health insurers that they would continue certain consumer benefits and protections no matter the Supreme Court's decision — such as immunizations, diabetes screenings and other preventive services without co-pays and allowing children to remain on their parents' policies until age 26 — Risa Lavizzo-Mourey, M.D., president and CEO of the Robert Wood Johnson Foundation, issued this rather feisty statement yesterday: "We applaud UnitedHealth, Humana and Aetna for their determination to not be held hostage by the political and judicial process and for their leadership in ensuring Americans have access to the health care they need. We encourage others to follow suit."

I welcome your comments. Email me at bsantamour@healthforum.com.