The Complex Equation of Health Care
Health care reform dominated the news during late 2009 and early 2010. It is not difficult to see why the issue generates such deep passions. Every American has a stake in the quality of the nation’s health care system as patient, taxpayer, and, for millions of doctors, nurses and others, provider. Any interested party in any health policy debate, from Medicare reimbursement policies to FDA approval procedures, can bring sick or injured individuals in front of the TV cameras and argue that their plight is related to a drawback in the current system.
The design of the health care system is substantively difficult as well as emotionally charged. We have all heard the sound bite that Americans spend enormous sums on health care and yet have health outcomes that lag many other wealthy societies. The facts and policy choices, not surprisingly, are more complex. We spend so much in part because of the substantial inefficiencies and distorted incentives created by our system of health insurance—itself the legacy of hundreds of individual policies embedded in the federal tax code, state insurance regulations, and other laws. But in part we do so because we are a very wealthy country that engages in constant technological innovation. Our challenge is to work on the former while celebrating and preserving the latter.
The link between our health care system and Americans’ health outcomes is also less close than one might imagine. In his book Health Care Half Truth, Dr. Arthur M. Garson, the University’s Provost and one of the nation’s leading health policy experts, observes that our public health system—including all our varied means of delivering and paying for medical services—is one determinant of health outcomes. A larger determinant, however, is personal behavior, including diet, exercise, and risky activities such as substance abuse and violent crime. Genetics is also a substantial determinant. The health care debate centers on the first of these causes but sensible policy will recognize the role played by the others.
Graduates of the Law School have played central roles in health care policy. As we know, health care reform was one of the signature issues of the late Senator Edward Kennedy ’59. Former Senator Evan Bayh ’81 was one of the Senate’s health care experts and Senator Sheldon Whitehouse ’82 was a vocal supporter of the ACA. In this issue of UVA Lawyer, we hear from Garry Carneal ’88, president and CEO of Schooner Healthcare Services about the management of health care delivery; Bruce Kelly ’76, former director of government relations for the Mayo Clinic; and Todd Zimmerman ’90, president of EmCare, a nationwide provider of outsourced hospital-based physician services. Professor Richard Bonnie ’69, one of the nation’s leading experts on mental health law, describes the potential impact of the ACA on the availability of mental health treatment.
Several states have challenged the constitutionality of ACA and, not surprisingly, commentators have looked to members of the Law School’s faculty for opinions on the constitutional questions. In these pages, Professor Fred Schauer steps back from the Commerce Clause and taxing power issues and asks a more basic question: how likely is it that the Supreme Court will grant certiorari in any of the cases challenging the ACA now making their way through the federal courts?
I hope you enjoy reading about the health care debate and the role that Law School alumni and faculty play in it.