Three healthcare experts spent an hour and a half at a Yale School of Medicine panel on Sept. 16 striving to bring clarity to a national reform debate they all agreed has been obscure, frustrating and ultimately unenlightening.
Yet the complexity of the issue and number of stakeholders in the nation's healthcare system was evident both in the panelists' commentary and the questions from the audience, who had gathered in Harkness Auditorium at the Sterling Hall of Medicine.
The Yale experts taking part in the panel were Jacob Hacker, the Stanley B. Resor Professor of Political Science; Dr. Stephanie Spangler, Yale's deputy provost for biomedical and health affairs and former director of the Yale Health Plan; and Theodore R. Marmor, professor emeritus of public policy and management at the Yale School of Management and professor emeritus of political science.
"We have had the most provincial debate imaginable," said Marmor, who moderated the panel discussion.
Hacker, a strong advocate of an expanded public option for health insurance, argued that the current political consensus to save the existing system of employer-based health insurance will end up making it impossible to reach goals of universal coverage while containing healthcare costs.
"It seems incompatible in some respects," Hacker said, citing the complicated nature of proposals put forward in Congress.
Hacker favors expanding the Medicare program to people under age 65, contending that providing such an option would hold down costs.
Spangler emphasized the need to improve clinical care. "Our system is fragmented, complex, unreliable and almost impossible to understand," she said.
She stressed that people who deliver and pay for healthcare services must be accountable for the health of patients. While recognizing the need for cost containment, she said she was worried that spending cuts would hamstring efforts to study the most effective treatments of patients, which will lead to big cost savings in the future by weeding out expensive therapies that do not improve patient health.
"We lack the data to know what works and what doesn't," Spangler said.
Neither Congress nor President Obama has clearly defined what a public option would look like, said Marmor, noting that politicians have yet to be honest about identifying where cost savings can be found.
Marmor agreed with Hacker that expanding coverage of uninsured while relying on employer-based health insurance was unlikely to stop increases in health costs. In two countries where such a system was tried — Switzerland and Holland — costs continued to rise, he noted.
However, Marmor also predicted that a truly sweeping reform is not likely given the politics of healthcare coverage.
"The central question is what incremental steps will put us on a glide path to a better health care system," Marmor said.
A video of the panel discussion can be found on the Yale Office of Public Affairs website: http://communications.yale.edu/.