Looking at the Affordable Care Act Through a Pre-Med Lens

Dr. William M. Sage speaks at UT Austin

Dr. Sage holds "the most expensive medical
technology in the world."

Last week the UT Kappa Rho Honor Society hosted an informal talk with MD/JD Professor of Public Health, Dr. William M. Sage about the intersection of law and medicine.  I attended along with about 30 of my peers hoping to hear an expert's perspective on the week's events in the Supreme Court and the future of medical practice in America. Dr. Sage is the vice provost for health affairs at The University of Texas at Austin and carries an impressive resume that includes a joint degree in medicine and Law from Stanford University, membership in the President’s Task Force on Health Care Reform in 1993 under Bill Clinton, numerous publications, awards as well as seats on the leading committees in the field of health care policy and research. Last week he composed lengthy blog entries about the Supreme Court proceedings for Health Affairs online.  

I admit I’m particularly unqualified to write about this subject, having spent the last three years with my head buried in chemistry textbooks and with a generally panicked outlook on my career future.  I have not read the Affordable Care Act, nor have I read the transcript of the Supreme Court proceedings but I have been paying attention.. I have been addicted to NPR’s coverage of the story and, I thought, if anyone could wade through the complexity of health care legislation, Dr. Sage seemed qualified to do it.

At the outset, he asserted “You should expect yourselves to become leaders and society should expect you to be leaders...” He went on to describe the current state of health care in this country as “mediocre” at best.  It is a system whose structure and culture are inhospitable to efficiency and fair commerce; “a huge cottage industry.” Doctors don’t think they are being compensated appropriately and patients think they overpay.  At one point Sage borrowed a pen from an audience member in the front row, holding it up, he called it “the most expensive medical technology in the world.”  He said doctors are responsible for the strain of “a largely discretionary, often unjustified expenditure of a trillion and a half dollars a year... to write prescriptions for drugs, referrals for services, hospitalization, diagnostic imaging etc., etc..”

Title III of the Patient Protection and Affordable Care act of 2010 addresses these concerns.  Last week the Supreme Court did not. So what does an aspiring doctor take away from the discussion? On one hand, the Court makes it seem like the future of health care in America hinges on an individual mandate to buy insurance.  On the other hand, Dr. Sage, says the insurance problem merely scratches the surface of the reform this country needs.  The admissions essay answer is that the discussion doesn’t matter; what matters are the patients.  But what myself and my peers often fail to appreciate is that our job satisfaction and our success at being healers depends a great deal on this discussion and what we have to say.  

If Dr. Sage is right, then the future of healthcare is uncertain. I don’t think any doctor would argue that being allowed to take control of a patient’s treatment requires doing it responsibly and efficiently. And I don’t think any citizen would deny that society would benefit if people did not go bankrupt because they got health care.  Furthermore, by taking responsibility for the delivery of preventative care a reformed system can keep society from having to pay for people who are already sick. It is uncertain how we can reconcile all of these goods without sacrificing the goods in our current system. My hopes echo what Dr. Sage wisely advised; in the future doctors will no longer “merely deliver services,” but will take a leading role in shaping the future structure of American healthcare, not just the way it is paid for.  We can, hopefully, overcome many of its flaws and build a great system.