James Barba wanted to shed his titles for a moment. He had spent most of Thursday’s symposium on the Affordable Care Act speaking as president and CEO of Albany Medical Center.
Now, he was going to speak as a citizen.
“I think yesterday’s decision was dead wrong,” he said from a table inside BlueShield’s Latham headquarters, “and this is the first time I’m saying that in public, and probably the last. They shouldn’t have done that. It was a terrible, terrible mistake.”
Barba is a lifelong liberal Democrat. He heads the region’s largest hospital and wants to see the uninsured receive care. But he also wants to see someone do something about the 10,000 new positions that will be needed now that the U.S. Supreme Court has upheld the president’s marquee policy, the shining beacon of accomplishment from his already historic presidency.
Barba’s concluding commentary during the BlueShield-hosted panel discussion with area health care experts was a departure from the glass-half-full outlook of his peers. But at the moment, he was talking as a constitutional junkie and not a health care provider.
“From my heart, I believe what happened yesterday did tremendous violence to that constitutional system of separation of powers,” he said. “Typically, I would expect that when the high court does take defective law, they hand it back to Congress and say, ‘Here, do it right.’ The chief justice did not do that; instead, he said, ‘Well, I think Congress should have done it this way.’ ”
There was one other constitutional junkie at the table Thursday morning. Alicia Ouellette, an Albany Law School professor and Union Graduate College professor of bioethics, said that in terms of health reform and the implementation of the ACA, Thursday’s ruling largely left political questions, not legal ones.
In fact, she said Chief Justice John Roberts found a way to show respect for the legislative process with what she believes was a last-minute change of opinion.
“What Roberts did was he righted the Roberts court in a way that gives the court integrity,” she said, “and he showed judicial restraint so that the legislative process can do what it needs to do.”
If the ruling did anything for the public’s understanding of the Affordable Care Act, it wasn’t much, said BlueShield of Northeastern New York Vice President Brian O’Grady.
“The level of clarity has gone from cloudy to hazy,” he said, eliciting nervous laughter from a crowd all too aware of that truth.
Panelists did agree the near-universal health care implemented by the ACA will continue to be an ongoing issue, just like Medicare and Medicaid have been since their inception.
But politics and punditry aside, the patient is at the center of the issue. Patients will be more empowered under the ACA, said Dr. Edward Yoon, a family practitioner with Community Care Physicians and medical director at BlueShield.
“But that’s not necessarily something that everybody wants,” he said. “It’s hard to resist Happy Meals and cheeseburgers and pizzas and sodas. It’s hard to get out there and exercise. It’s hard not to drink and smoke so much.”
But if Americans want a sustainable health care system, they have to think about the consequences of their health choices, said Yoon.
“It’s going to affect not just our health, but also our bottom line,” he said.
Cost containment within American health care will continue to be an issue.
“There seems to be bipartisan agreement that something has to be done about cost,” said CapitalCare Medical Group CEO Joan Hayner. “We can’t go backwards or do more of the same and expect we’re going to take cost out of the system.”
So the law was upheld. What now?
The public needs to be educated about their options, said Hayner. For the uninsured who will now have access to coverage, that means knowing what the appropriate care is. Is it getting 10 MRIs for a bruised ankle or is it rationed care?
“You’ve got a health care need,” she said, “but how much health care? What kind of health care? And we have got to make a much more concerted effort and have honest discussions about what is appropriate care, and I think a lot of it has to come down to doctors. It’s not the government, because the government isn’t trusted. The doctors are trusted.”