On Thursday, March 4, a group of students, faculty and Hamilton community members gathered in the Persson Hall Auditorium to hear different vantage points surrounding the issue of health care reform in the United States. The Patient Protection and Affordable Care Act, a sweeping reform of the American health care system, was signed into law on March 23.

Former President of Blue Cross Blue Shield of Illinois Paul Boulis, Vice President for Hospitalist and Primary Care Services of Community Memorial Hospital Dr. Robert DeLorme, Associate Professor of Economics Jyoti Khanna and Family Practitioner at Bassett Healthcare of Hamilton Dr. Ellen Larson ’94, served as panelists, with Director of Student Health Services Dr. Merrill Miller serving as the moderator.

Khanna, who teaches a course in Health Economics, began the discussion by acknowledging that the U.S. healthcare system, which is the most expensive in the world and is vastly dysfunctional, desperately needs reform. As Khanna pointed out, 18 percent of the U.S. GDP is spent on healthcare. Even with all the money put into it, the system is not very effective; the U.S. is ranked 37th out of 191 countries for its health care performance.

According to Khanna, there are several reasons why America spends so much on health care. Instead of receiving a fixed income, the amount of money that physicians make is based on the services that they provide. Because of this, there is an incentive for them to overprescribe, as it increases their income. The threat of being sued for malpractice creates another incentive to order more tests.

Despite all the money put into the healthcare system, the number of people who have no access to health care at all is increasing. The proposal presented by President Obama would mandate insurance for everyone and would not be based on risk. Subsidies would be provided so people in lower income brackets would be able to participate.

Paul Boulis, who worked for insurance giant Blue Cross Blue Shield, said that the current debate is rooted in whether it is possible to disrupt the long-standing structure of employer-provided insurance. Instead of questioning the system itself, people tend to attack insurance companies, he said. However, he said, the profits from health insurance companies only account for two to three percent of the cost of the health care industry.

In Dr. Robert DeLorme’s opinion, in order to move forward, the system itself needs to be changed from the bottom up. He doubts, however, that the American public will be able to adjust and accept such a change.

Dr. Ellen Larson pointed out that with so many specialists and so few general practitioners, changing America’s system of insurance will not make a substantial difference. Nurses and general practitioners are paid very little compared to specialists, so there is little incentive for those in medical school to choose to be a general practitioner. An effective way to cut costs, Larson

believes, is through education and prevention.

Dr. Merrill Miller further suggested that hospitals should standardize procedures and keep electronic records, so as to cut costs and eliminate the numerous tests run multiple times because their originals could not be located.

According to Boulis, if Obama’s proposal were to pass, it would take little to no time for certain aspects of it, such as coverage to certain groups, to take effect. Other aspects, such as Medicaid elements, would be phased in, some taking as long as three to four years to be completely active.

Although the panelists all had slightly different takes on the issues of healthcare and how it should be handled, they unanimously agreed that mandated coverage is a non-negotiable element of Obama’s plan. With the recent passage of the Bill, these mandates will start to take effect as the prior U.S. healthcare system begins to change.