A Florida’s judge’s ruling that the Accountable Care Act (ACA) is unconstitutional doesn’t resolve the underlying constitutional issue (which will ultimately have to be decided by the U.S. Supreme Court) but it has introduced new uncertainty for the $2.3 trillion health care industry, and emboldened the law’s critics to push even harder for repeal (not that they weren’t trying already).
The Wall Street Journal’s (WSJ) health blog reports that “states and companies that are supposed to be implementing the law trying to figure out what to do next. The WSJ reports that the 26 states that are parties to the suit are considering whether to ask the Supreme Court to take up the case now, before it has fully wended its way through the legal system. The New York Times (NYT) quotes the governor of Florida as saying that until the fate of the law is clear, “we’re not going to spend a lot of time and money” to implement it. Other states, even if part of the suit, will move ahead,” the NYT says. The WSJ also reports that most health care companies plan to “stay the course” and continue to plan for the law’s implementation. Meanwhile, the Obama administration says that the judge’s ruling will have no effect on the implementation of the law or the requirement that states (including those who brought the suit) comply with its mandates and claims that most constitutional experts agree with the administration.
Now, I am not a lawyer, so I don’t have any expertise on the legal arguments over the ACA’s constitutionality. For those of you who want to hear more about the constitutional questions from people who might actually know what they are talking about, I recommend this Health Care Blog post from attorney Mark Hall, a critic of the Florida judge’s ruling. He notes that “at least half of the relevant part of the opinion is devoted to discussing what Hamilton, Madison, Jefferson and other Founding Fathers would have thought about the individual mandate” (Judge Vinson concluded that they would not have approved of it) but “the same Founders wrote a Constitution that allowed the federal government to take property from unwilling sellers and passive owners, when needed to construct highways, bridges and canals.” The Washington Post’s Ezra Klein — a supporter of the Affordable Care Act — has posted an excellent overview of what legal experts are saying about the ruling, pro and con, including a link to a posting that argues Judge Vinson ruled correctly. Read more »
While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care.
A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve.
Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reasons include that primary care physicians won’t have the time to keep up with the extra workload, forcing more patients to depend upon nurse practitioners for primary care. When asked who will likely handle the 32 million Americans expected to receive healthcare following passage of the reform, 44 percent said primary care physicians will handle the load and 44 percent said that nurse practitioners will see them. (Physicians could vote for more than one category; options include physicians assistants and specialists, for example.) Read more »
*This blog post was originally published at ACP Internist*
Mrs. Happy and I just returned from Disney World for our Happy family vacation. (It was either that or a Parkinson’s Cruise.) While at Disney’s Epcot Center, Mama and Papa Happy discovered what the future of healthcare in America will look like, and it has nothing to do with insurance.
You’ve all seen that giant Epcot ball. Inside that ball is a slow-moving ride that takes you through thousands of years of history. At the end you choose your own future. I present to you this video showing the future of healthcare in America, courtesy of the Epcot Spaceship Earth and Mama and Papa Happy:
A couple words of mention. They still think there will be doctors in the future, unless their reference to doctors was reference to future nurse practitioners known as Dr. Nurse. That’s quite possible. Maybe that’s why the future of healthcare has nothing to do with medical care or insurance and has everything to do with healthy lifestyle. You don’t need to be a nurse for that, you just have to accept the truth of healthy living. And you don’t need a medical school education or even nursing education requirements to make that happen.
The future of American healthcare will not value physician education. Perhaps it’s time to abandon the medical school model and train millions of nurses instead at a fraction of the cost. This comment was left on my blog over at NP=MD:
I don’t even compare NPs and MDs. Their models differ. One is not better than the other. The schooling — minus the residency — is nearly equivalent in terms of time spent. The problem is that NPs don’t get a long enough residency. If you take a NP and a MD, both with 20 years clinical experience, the MD does not know more than the NP. Sure, he had a few extra classes 20 years ago — which he doesn’t remember — but that’s about it.
NPs aren’t trying to steal MDs’ meal tickets, they’re attempting to better serve patients. Read more »
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