Are We Fighting the Wrong Healthcare Battle?

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Although the United States Supreme Court may have finally put to rest any constitutional disagreements over the Patient Protection and Affordable Care Act, the debate over healthcare is far from settled. Finding critics of the landmark decision is as easy as surveying the Court itself, since each of the eight remaining justices took issue in one way or another with the majority opinion by Chief Justice John Roberts. It therefore comes as no surprise that the aftereffects of the Court's 5-4 split have already trickled down through nearly every aspect of federal and state government, providing scores of pages of partisan fodder that will ensure both sides have ample stock of rhetoric to flame this debate for years to come. For this reason, now is the time to ask ourselves if the nation's focus is on the wrong questions. If so, the answers over which we now debate are of little value.

Pilots, prevention and reimbursement cuts

In many ways, the PPACA is a trillion dollar gamble with a trifold agenda that attempts to address the future. At its core, the bill seeks to improve the long-term health of Americans by promoting innovation in the delivery of medicine, placing stronger emphasis on the prevention of disease and enhancing education in the adoption and maintenance of healthier lifestyles. More often than not, however, such laudable goals are overshadowed by the fact that it also seeks to expand accessibility to the 50 million Americans who are currently uninsured. In this light, the PPACA becomes a theory without guarantee, and its success is in large part contingent upon the woefully deficient system it seeks to replace. Whether or not the United States can afford to plan so far ahead in its current economic climate plays an understandably overwhelming role in this debate.  

Without adequate funding for the PPACA's collection of pilot programs, preventative healthcare services and forward thinking research, the only remaining viable option for Congress is to reduce provider reimbursement until such time as American healthcare can stabilize. Should this occur, it will be difficult for medical schools to graduate those willing and able to honor the Hippocratic Oath with the same degree of skill and integrity exhibited by physicians today. Just as we believe the creation of something spectacular will draw those from far and wide to marvel at its splendor, should we break it, the crowds will leave. Our newfound entitlement to healthcare will have little meaning if in the future there is no one left to deliver it.

Lack of patient incentives

While the PPACA is far reaching in its outlook, a fundamental flaw is that it lacks any meaningful mechanism to instill a sense of pride for individual health, and it fails to educate the people that they must respect their right to healthcare. Although Americans will likely never come to a consensus on such ethical topics as when life begins or when it should come to an end, surely few will disagree that from a practical standpoint the best way to reduce the burden on healthcare is to collectively live healthier lives requiring less of a demand on the system.

The alternative to this option will be the creation of a healthcare infrastructure that is unsustainable, resulting in fewer physicians providing inferior care. Such a fear should have been central to the healthcare debate from the beginning, rather than the primarily political issue of whether the individual mandate is a tax or penalty. Now that healthcare reform has at last received the attention it deserves, we as a nation might consider spending less time defining lines drawn between political parties and more time examining the symbiosis between patient and provider. For thousands of years, patients have relied upon physicians to extend lives, cure disease and promote well-being. With the PPACA comes a shifting of this burden from provider to patient, whose willingness to accept or reject responsibility for his or her own health may now determine the future through the ways in which we respect the right to healthcare.

Mr. Garner is an attorney and healthcare consultant, specializing in issues surrounding modern American healthcare and the ways it should be managed in its current climate of reform. From 2002-2011, he was the CEO at a community hospital in Los Angeles County, Calif. Mr. Garner teaches a course on hospital law at Pepperdine University School of Law in Malibu, Calif.

More Articles by Craig Garner:

Healthcare Reform: A Time To Wait, or Expiate?
Providing Care for the Uninsured Without the Federal Case
No Choice But To Care: What Happens When a Hospital Can't Shut Its Doors?

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