Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act's controversial individual mandate isn't likely for at least another several months, but it's worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less ...
Brad Wright
The public’s values of fairness in health inequalities
There are two camps in America: those who think that health care is a right and those who think that it's a privilege. Well, perhaps that's a bit of an oversimplification, but bear with me. Given these two respective positions, what are we to make of the health inequalities that are well documented in the United States? First, we must acknowledge that health is the product of multiple factors ...
The myth of undocumented immigrants using American health care
I hear it all the time: "All these illegals are coming over here and they don't pay taxes, but they get all these government handouts and they're clogging up our health care system ..."I often point out that many undocumented immigrants actually do obtain a taxpayer identification number for the express purpose of paying taxes in hopes that if a path to ...
Repeal of reform won’t fix our health system
The system we had before health reform became law was simply not working. I think we can all agree on that. A significant number of people oppose "Obamacare." I can understand that. But repeal doesn't really solve the problem. Sure, if you think that health reform has or will actually make our system worse than it was before, it seems prudent to undo the legislation, but that brings us back ...
Finding out the cost of lab tests is a real challenge for patients
In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.Fortunately, when I started graduate school, my father insisted that I ...
Is more primary care really better?
Proponents of health reform have long claimed that one of the biggest problems with our health care system is an overemphasis on expensive specialists and an underemphasis on primary care physicians -- who, much research shows, produce high quality care at a much lower cost.In essence, the argument is that we're using (and paying for) rocket scientists to fly kites. If we bolster the primary care workforce, suddenly we'll start ...
Uninsured Americans cannot afford many medications
I went to the doctor recently and got a new prescription.The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn't have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a ...
Should reduced ER use be a measure of health reform?
In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be ...
The public option dissonance in health reform
Health reform will do a lot of things that most Americans don't realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.One of the most recognizable components of health reform that didn't actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and ...
Health care needs public acceptance of evidence based medicine
Although a majority of Americans probably couldn't give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying--and often interchanging--those labels to any effort by government to reform health care.And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don't already ration, but will as soon as the government ...
How transparency reduces malpractice and defensive medicine
Physician errors have been the subject of discussions about both health care costs and health care quality.We are told that if we reform the malpractice system -- capping damages -- that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal -- there are estimates that nearly ...
