Today’s guest post: Jay Wolfson talks healthcare reform

Sometimes it’s handy for a doctor to have a public health expert around.

Today is one of those days. I’m turning my blog over to Jay Wolfson of the USF College of Public Health for a guest post on his thoughts about the Supreme Court opinion on the Affordable Care Act.

The USF Health College of Public Health’s Jay Wolfson, DrPH, JD, talks with media about healthcare reform today.

Here’s what Jay Wolfson has to say:

Today’s ruling from the U.S. Supreme Court will be the defining moment of  this court for generations to come. The court upheld the insurance requirement as a tax, and thus an area in which the power of Congress is clearer and more unequivocal. In doing so, the court showed that it is capable of taking the law as written by Congress and putting it into the context of Constitutional intent.

It was fascinating to see Chief Justice Roberts’ opinion, especially after the comments he made during oral arguments – comments that were uncharacteristic of the justices. He asked very probing questions about “What happens to me and my family?” “What happens to normal people?” His vote, along with those of other justices, inject a sense of humanity, as well as pragmatism, into the Supreme Court.

This ruling is going to be unpopular in some quarters. Many politicians and some lobbying interests will not be happy with the ruling.  States, for example, will have to find more money to pay for Medicare expansion that will bring more than 16 million uninsured persons into the program.  And philosophically, there are many in the nation who just don’t like the idea of the federal government being able to come into people’s lives and require them to have health insurance coverage.  But the battle between those advocating for more centralized federal powers versus control by the individual states has been raging since the signing of the Constitution.

The Supreme Court decision does mean that Floridians, along with other Americans, are going to receive more access to benefits through Medicaid. It means that parents won’t have to worry about their 18- to 26-year-olds losing coverage. It means that the elderly won’t have to worry about the gaps in their prescription drug benefits. And it means that most Americans won’t have to worry about being denied insurance coverage because of a pre-existing condition, or being dropped from a plan if they use too many benefits.

It means that Americans will have a safety net that’s real.

Still, reform doesn’t come with litigation and legislation alone. It’s going to come with cultural change in the way we practice medicine and the way we train physicians. It’s going to come with changes in our expectations about health care.

In this country, we pay too much for pharmaceuticals and dispense too many of them.  We prescribe too many unnecessary diagnostic tests.  We perform too many expensive and invasive procedures in hospitals. And the outcomes for all those things we do, all that money we spend, are surprisingly poor compared to the rest of the world. We get less bang for the buck than other industrialized and some developing countries.

If you get shot in the chest or hit by a truck, this is the best place in the world to come for care. But if you need preventive care, public health services, or if you have a chronic disease, this is one of the worst places to be. That’s because we focus on excessive and often unnecessary testing, pharmaceuticals, and expensive procedures.

It’s going to take more than this bill to change that.


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