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Hem/Oncs: Supreme Court ruling assures health care ‘business as usual’ will not continue
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Hematologists and oncologists continue to react to the Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act.
In the following perspectives, leaders in the field offer their opinions about the short- and long-term implications of the ruling.
Harry S. Jacob
By coincidence, the day before the ACA Supreme Court decision, I read an article in the June 25 New Yorker by Ezra Klein. It documented how politics had dramatically altered the predictability of the coming decision. Klein noted that shortly after Congress passed the ACA, “it was hard to find a law professor in the country who thought the law unconstitutional.” Moreover, Klein quoted a George Washington University professor, Orin Kerr, who had clerked for Justice Anthony Kennedy: “There is less than 1% chance that the courts will invalidate the individual mandate.” Well, 14 months later, the odds had become even after dueling campaigns by both political parties. The dueling will no doubt continue and will be energized by the surprising and determinative opinion of Justice Roberts, who found constitutional the individual mandate based on the federal government’s taxation authority. The term “taxation” — emotionally charged and politically divisive — will undoubtedly be a central issue in the upcoming election campaigns. I hope that the following data will somehow inform the debate: namely, the cost of health care in the United States is at least 30% higher per capita than in all other comparable developed nations, even though some 50 million of our citizens (until now) have no health insurance. A significant reason for this dichotomy is the tens of billions of dollars we Americans spend annually to provide inefficient health care in emergency rooms to the uninsured — not to mention the economic (and moral) disaster of lost wages and even lives due the unavailability of preventive medical interventions for the uninsured. Thus, our population at large is already “taxed” to provide the extra funds for our uninsured brethren. If 250 million insured folks are providing tens of billions of wasteful dollars to the uninsured, they are already victims of hidden taxation that currently works out annually to a few thousand dollars per person. I look forward to the upcoming debate with hopes for a more equitable and efficient health care environment in the future.
— Harry S. Jacob, MD, FRCPath(Hon)
HemOnc Today Chief Medical Editor
Disclosure: Dr. Jacob reports no relevant financial disclosures.
Donald L. Trump
This decision is important. It not only affirms that the ACA will proceed to implementation and, hence, will have a positive impact on access to medical care, it will favorably influence the availability of comprehensive care to cancer patients as well as increase access to screening and preventive services. In addition, it allows the important national conversations regarding continued improvements in how we organize and provide care to continue. I had feared that if the ACA had been overturned, there would have been chaos and continuation of a “business as usual” in health care. Business as usual is unsustainable.
— Donald L. Trump, MD, FACP
HemOnc Today Editorial Board Member
Disclosure: Dr. Trump reports no relevant financial disclosures.
In one sense, the passage of the Affordable Care Act had the effect of moving the train out of the station when it comes to health care financing reform in the United States and put us on track toward a more universal system of coverage of health care financing. By upholding the individual mandate as something that the Congress has the authority to regulate through taxation, coupled with allowing states to opt out of exchanges and not be forced to take on an increase in Medicaid population coverage, the ruling actually could accelerate the discussion about a federal model in which individuals can purchase a federalized version of health care insurance. It might have the paradoxical effect of accelerating the pressure toward the federal government as a payer of last resort for more and more people.
— J. Robert Beck, MD
Chief academic officer, Fox Chase Cancer Center
Disclosure: Dr. Beck reports no relevant financial disclosures.
Victor J. Dzau
The US Supreme Court decision on the Affordable Care Act adds much-needed direction on the issue of health care reform, even as there will likely be ongoing challenges. What is undisputed is that the law’s goals of increasing access to care and lowering costs are imperative, and we absolutely support them. It will now be incumbent on those of us in the health care delivery system to assure that such objectives do not come at the expense of quality, which is an equally important aim. We are already moving forward on this. Hospitals, health systems, payers and providers have been working to meet the requirements and the goals of the law, and this decision will accelerate those efforts. That is a good thing for everybody needing health care. With expanded insurance coverage, more people will have affordable access to routine care through a primary care physician, have a greater ability to focus on prevention and wellness, and avoid utilizing high-cost emergency departments as their medical care. As a large health care system, we must now concentrate on ways to accommodate the potentially huge demand for primary care providers. We must also continue to focus on innovation, quality and efficiency. Although the Supreme Court ruling provides clarity, there remain many unknown factors that will affect how hospitals and doctors oversee care, particularly for the millions who will still not have health coverage despite the law’s mandate. Such details will take form as the law unfolds, and time will tell how well it is implemented. But I can say with conviction that increased access to high-quality, affordable care is a goal that absolutely must be achieved.
— Victor J. Dzau, MD
President and chief executive officer, Duke University Health System
Chancellor for Health Affairs, Duke University
Disclosure: Dr. Dzau reports no relevant financial disclosures.
Philip L. McCarthy
The big impact for hematology/oncology and cancer centers such as Roswell Park Cancer Institute is in addressing coverage for clinical trials. This has been a big problem in that some insurers will not allow patients to participate in clinical trials, limiting our ability to advance the field. We can expect that now that this barrier to coverage for new and investigational therapies will be eliminated, the pace of treatment advances will pick up. Coverage for more patients is good; however, a major issue is how we pay for more technology. We will continue to face these financial issues as we get better at treating patients with newer pharmaceuticals and techniques that are expensive.
— Philip L. McCarthy, MD
Professor of oncology, Director of the Blood & Marrow Transplant Program
Roswell Park Cancer Institute
Disclosure: Dr. McCarthy has served on advisory/consultation boards for Celgene.