As the Supreme Court hears arguments for and against the Affordable Care Act, two professors from Princeton University and the Harvard Kennedy School of Government came to Yale to speak about health care reform in the United States.
At the talk, Amitabh Chandra, an economist and professor of public policy at Harvard, discussed specific problems with the nation’s health care system, such as inefficient coverage and costly treatments. Paul Starr, a professor of sociology and public affairs at Princeton and former Pulitzer Prize winner, focused on issues that are currently before the Supreme Court, and explained his personal concerns that the ACA may be knocked down by the court.
Known to many as “Obamacare,” the ACA was signed into law in March 2010 and is the largest piece of health reform passed since Medicare was created in 1965. Proponents of the bill applaud it as long-overdue legislation, while dissidents say it oversteps the powers of Congress and will be ineffective. These arguments have also been made along strict party lines, with Democrats largely in support of the bill and Republicans mostly against it.
Starr spoke about the ACA’s controversial government mandate that requires all American citizens with sufficient resources to purchase health insurance fulfilling basic requirements. He said lawmakers would have benefited from advocating an automatic enrollment policy with an opt-out option rather than the mandate. Such an option he said would have prevented constitutional problems, he said, and still decreased the uninsured population because research has shown that people rarely opt out in similar situations.
The constitutionality of the ACA and its associated mandate have been challenged fiercely in the lower courts over the past two years, and Supreme Court has spent the past three days debating the case with attorneys representing both sides.
“As someone who’s been pushing for health reform for quite some time, it was disturbing to hear the oral arguments [Tuesday] at the Supreme Court,” Starr said.
Starr said he has always been worried about the mandate causing constitutional problems and generating negative public sentiment. He expressed concern that the public would interpret the idea of a “mandate” as similar to a compulsory military draft. But the consequences of noncompliance with the two are very different, Starr said, as the government can only “withhold a tax return” should someone decide not to buy health insurance and refuse to pay the resulting penalty. Avoiding the draft is a federal offense that could result in up to five years of imprisonment and a hefty fine.
Chandra then discussed the nation’s “national health care trilemma” — problems with insurance, quality and costs in the health care system.
“Even if [the ACA] stands, there is still much to be done,” Chandra said. “Americans are only receiving 55 percent of what they could be getting [in terms of health coverage].”
In outlining problems that plague the current U.S. health care system, Chandra discussed Medicare’s fee-for-service payment scheme, which he said encourages doctors to overutilize services rather than perform thoughtful procedures. He showed a slide of a brochure advertising scanning equipment for urologists that included a table outlining how physicians would earn more by increasing how frequently they ran the machine for daily procedures over a five-year period.
Chandra added that the government has refused to analyze treatments based on cost-effectiveness.
“We would rather take tax dollars to pay for unproven medical technology three times over [rather than using the] money to insure the uninsured,” Chandra said.
Physician Moreson Kaplan and nurse Nina Adams, two retired Yale employees who attended the talk, said they enjoyed the speakers’ presentations.
Kaplan said Starr explained his well-known and published views clearly. Adams praised Chandra and Starr for presenting an “enormous amount of information,” adding that she thinks those who are less informed about the health care system and ACA have contributed to the craziness of the health care debate.
Gabe Scheffler LAW ’14, who helped organize the talk, said he thinks the mandate is “absolutely constitutional.”
“You’re essentially born into the health care system,” Scheffler said. “By choosing not to purchase health insurance, that effectively means either that you’re going to pay out of pocket … or that someone else is going to foot the bill, and that in itself is an economic decision.”
The Supreme Court will release its decision on the constitutionality of the bill in late June.