How Will Hospitals Change after the Supreme Court's Ruling?

Thursday, June 28, 2012

hospital, ER, Dr. Lewis Goldfrank (center) discusses a patient with medical residents. (Benjamin Norman Photography)

The political guessing game is over: the Supreme Court has ruled on President Obama's health care bill, the Affordable Care Act. Hospitals across the country are already adapting to a growing number of uninsured Americans, but today's announcement that the individual mandate for health care is constitutional will have very substantial repercussions for the entire industry of medical services.

Wayne Keathley is not only the President of Mount Sinai Hospital, he's also the COO, responsible for the day-to-day operations. He points out the risks that uninsured Americans pose to both themselves and to society as a whole, and favors a fundamental shift in the healthcare system towards preventive care. 

"We have faced the mounting pressures of an aging population, a persistent segment of the population is either uninsured or underinsured, and the growing paradox in this country of the increasing need for primary, preventive care, and yet our reliance on what I call rescue medicine, which is basically tertiary and quaternary services provided to people at the acute moments of illness in their lives," Keathley says. He sees the need for a different debate on healthcare; one that brings more attention to social policy issues that could ease the healthcare system's burden, along the lines of the old saying, "An ounce of prevention is worth a pound of cure."

For the COO, the idea that uninsured people do not pose a risk the healthcare is an "annoying myth." "Because people are uninsured, somehow that doesn't have an economic consequence," Keathley says. "Of course it does — Mt. Sinai alone provides lose to $80 million a year in charity or uncompensated care." 

Keathley highlights the same problem that the documentary "The Waiting Room" explores — people without insurance make use of the nation's emergency rooms for low acuity care, which has an adverse affect on everybody in the system. "Instead of having routine access to primary acare and preventive medicine, which would lower the cost for everybody and certainly be a more desirable outcome for patients and their families, they're forced to forego those things and seek care when it's absolutely essential and when it costs the most, and does the most damage," Keathley says. 

The COO makes it clear that even if if the Affordable Care Act is passed in its entirety, it will only be a few steps forward. "People shouldn't be fooled — there has to be next steps, regardless of today's decisions. Even if this is fully upheld, we're only part way along where we need to be to reform healthcare. If it's reversed, then obviously we have to go back near to the starting point." 

What Keathley fears most is the passage of bits and pieces of the Act, which could mean too many mandates and not enough funding to adequately pay for them all. "[If that happens], once again, hospitals, emergency rooms, and physicians and nurses wind up paying for the ever-fraying safety net," Keathley says.


Wayne Keathley

Produced by:

Robert Balint, Joseph Capriglione and Joe Hernandez

Comments [14]

Carol from Minneapolis

I have a very rare genetic disease; I've had 5 abdominal surgeries; I have had cancer. I am self employed. I cannot buy life or health insurance at any price on the open market. I am so very glad Justice Roberts found a way to support this life-saving legislation. Can we all now go forward to get health care for everyone; not just the wealthy and the well people.

Jun. 28 2012 04:30 PM

How do you fix the abuse? As the ambulance driver who would advise the person without insurance to go to the clinic to save the emergency room, believing that suffering is also monetary, I applaud this decision. However, I have seen abuse of the system provided free to poverty stricken individuals. Often taking people who are provided this insurance for free, to the emergency room for no legitimate health problem and often multiple times in one day. I live in a state that has implemented a similar health care / medicare law.

Jun. 28 2012 03:51 PM
Bob O'donnell

Nobody is discussing one of the main causes for the escalating health care costs - the tremendous duplication of health care facilities. We do not need every hospital having expensive diagnostic equipment. Some cooperation between hospitals is required.

Jun. 28 2012 03:43 PM
Chris from Bend, OR

Affordable? I just checked the Oregon Health Exchange site for an estimate of what my contribution will be and I will have to come up with 254.00 per month. If I had 254.00 per month of disposable income then I would have health care already!

Jun. 28 2012 03:23 PM
Bianca Castafiore from Marlinspike Hall

In order to honor the request to be brief, I'm providing a link to one of my blog post that explains my health care story. It's an ongoing story, even having a huge development just yesterday. And I know no one really cares, except people paid to and those who might love me, but I think my story is an example of oh-so-many of the things at stake today, chez SCOTUS.


Take away my access to ACA and its many excellent provisions? Maniacal laughter and... well, the only choice left.

Jun. 28 2012 10:00 AM
Leslie Hauser from Hallandale, FL

I am in favor of it. I am 61 years old and work, but my company gives no benefits. For a person of my age, the cost of health insurance is astronomical. This system, if passed, will make health insurance more affordable for people like me and for those who already have insurance who pay for those who use the emergency rooms and can't pay. Single payor health insurance would be the best. In this way, maintaining ones health would change from being a for profit industry to a right for all. I would be more than willing to pay more taxes for health care.

Jun. 28 2012 09:42 AM
Don Calvert from Fort Lauderdale

I have been involved in employee benefits for 30 years and the one thing I would change is to require everyone who works to have Medicare Part A which is coverage for hospital care. Most people can find a way to pay a doctor but a uninsured hospital bill is financially devastating. I had a 1.5 day hospital stay in April where the bill was $89,000 before insurance discount and $29,000 after hospital discount. Who could afford the $29,000 without insurance?

Jun. 28 2012 09:36 AM

As co-author of the 2nd edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration, I have watched the debate with great interest. Of particular note is that the decision is likely to turn on legal and political philosophy, not health or health care issues. No matter the decision, changes in the population, technology, the economy, and scientific knowledge are all driving changes in the system that require negotiation among all relevant stakeholders.

Given that everyone on the Court and who argued in front of it are secure in their health care, they have the luxury of ideological debates. If we could move beyond that to problem solving that engages all of the stakeholders, we'd be more likely to find solutions that benefit the many including ways to control costs and increase quality.

Jun. 28 2012 09:27 AM
David from New Hampshire

My wife and I are both 62 years old. My wife is disabled with multiple medical issues. She cannot work. She require numerous prescriptions, some of which are extremely expensive. I have leukemia and type 2 diabetes. I too need multiple prescriptions, one of which (an injectable) retails for about $4,000 monthly.

Until December of 2011 we were insured through Harvard Pilgrim. Because I am self employed with a small group (two of us), Harvard increased our premiums by 48% in December 2010 and again in December 2011. Thar second increase brought our monthly premium to $3,960.00 a month. We simply could not afford that cost. We were in danger of losing our coverage entirely. Whether we lost our coverage or found a way to pay the premium, we would probably have lost our house and our few assets. Also, had we lost our coverage, we would have become emergency room patients for all medical problems, or we would have died early deaths.

Obama-care saved us. We are in the mandated high risk pool. That cost $1,450 a month for decent coverage, although prescriptions cost about twice what they did with Harvard. Still, we can manage, although I did need to give up that one expensive injectable.

Jun. 28 2012 09:19 AM
Matt Laurence from Jamaica Plain

The health care system in our country is very good; it is the INSURANCE industry that is causing all the pain. They are middlemen, bloated costs that add no value at all. If we put all that money into actual care, no one in our country would want for any health services.

Jun. 28 2012 09:13 AM
Linda from Florida

I have been unemlployed for over a year. Although I was healthy before this, I have used my time away from work as an opportunity to train for half marathons, get back into kickboxing and learn to cycle with a road bike. I am 48 and healither than most people I know regardless of age. Imagine my surprise and dismay at the fact that I cannot get health care because I had squamous cell carcinoma two years ago which was promptly treated. Every insurance company I've tried has denied me or offered coverage at a price that is well beyond economically feasible. I am a very healthy risk and squamous is very treatable... I just don't understand. Something has to change.

Jun. 28 2012 09:10 AM
Ed from Larchmont

Your callers show what everyone believes: that we need healthcare reform. The question is whether this is a good way to do it, and those who think no hope it's not upheld.

One thing: if the absence of religious exemption stands, Catholic hospitals will close or end their Catholic affiliation, which will decrease care for the poor.

Why not just call the President's office for opinions about the law?

Jun. 28 2012 07:29 AM
amy from paris from paris

I've been living in Paris for several years where people simply can't understand how it's possible to go bankrupt or have to refinance your house to pay for medical care. Here the thinking is, we're all mortal beings so no matter what we do, we can't NOT purchase health care at some point in our lives. It's not a choice. Health care is an inelastic good that can't be treated like other commodities because when we need it, we can't just decide not to buy it if we don't like the price, like we could with broccoli, for example. Here, the government helping to provide for the general welfare of its citizens is seen as the ultimate stage of an advanced democracy.

Jun. 28 2012 06:45 AM
Ed from Larchmont

With the Eric Holder contempt charge and the health care ruling this could be a bad day for our anti-Catholic, pro-abortion president. But even if the health care law stands, it still has to face the law suits filed last month by the Catholic Church on religious freedom grounds.

Jun. 28 2012 06:03 AM

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