Supreme Deliberations

This is perhaps the most significant week for the future of healthcare our country has experienced since the Johnson administration in the mid-1960’s.  The Supreme Court is hearing the arguments on the constitutionality of the Affordable Care Act.  Their ruling will come later this summer but the legal maneuverings are at a fever pitch.  People have waited in lines all weekend to be in court to hear what will be some of the most monotonous arguments, that will be understood by so few, but will affect so many of us.

One of the most informative opinions on what this means was written by Dr. Ezekiel Emanuel, one of our country’s leading bioethicists.  This piece that was published in the NY Times last week points out all the incredible things the ACA has already put in motion that will continue, regardless of how the court rules.  Living in Chicago, I love the Emanuel family story.  Everyone knows Rahm, President Obama’s Chief of Staff and now “Da Mayor” of our city.  Ezekiel is an oncologist and a bioethicist.  Perhaps the most famous of the three brothers is Ariel, who is a Hollywood agent, and inspiration for the character Ari Gold in HBO’s Entourage.  What I love is the passion each of them brings to their work.  It is infectious and inspires the rest of us.

I have no idea how the court will rule on the ACA, but love that the entire country is focussed on this issue.  In so many ways, the real facts about healthcare are being  brought out from “behind the curtain”.  Everyone is pointing out the $2.5 trillion healthcare number and the fact that it is 16% of GDP.  Once again, we are discussing the uninsured, but now we have solid options as to how to pay for their medical needs.  We are proud that the pre-existing conditions issue has been dealt with through private insurers.  These are big issues that require big thinking.  Regardless of which side of the debate we stand on, I love that everyone is thinking about the options.

One of the most interesting issues to me throughout the debates is how little recognition the public has of the role of government in the payment of healthcare in the US.  The famous cry during the debate, “Keep the government away from my Medicare” perhaps symbolizes the lack of understanding of this issue.  The chart in the The Atlantic piece shows that the US government now spends almost $4,000 per person on healthcare per person.  If you then add the $300 billion or $1,000 per person for the tax break given employers for their purchasing insurance this number comes to $5,000, which is over 60% of the healthcare bill.  I recognize that this is 100% for a large percentage of people and a lesser number for those who do have private insurance, but for only a very few of us the number is zero.  The government clearly matters and I would argue without their support the entire industry would tumble.

The challenge today may be two-fold.  First, given the huge role government plays in our industry do we really dedicate the personal and collective resources to understand and work within their systems?  Secondly, given the various different scenarios that could arise after the court rules this summer, do we have plans in place for every potential outcome?  The states are furiously planning.  The insurers are definitely going through the potential outcomes as their future is tied to the results.  Physicians and hospitals are trying to determine how they can win with any of the outcomes.  Are we in the pharmaceutical world dedicating the same energy as our customers are to this market changing event?   My bet is some definitely are and some are not.  Care to guess who will win and who will lose once the court rules?

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