Student Medical Ethics Society Examines Controversial Health Care Bill from Practical, Ethical and Halakhic Perspectives
American health care is facing its most comprehensive overhaul since 1965, and everyone from doctors to patients to employers will be affected. Often referred to as “Obamacare,” the Patient Protection and Affordable Care Act (PPACA) became one of the most contested topics in this year’s presidential election, and its political, financial and ethical implications are still widely debated. On November 26, Yeshiva University’s Student Medical Ethics Society sought to debunk the myths and misconceptions about the controversial health care bill at an event that provided students with a practical walkthrough of the complex bill and analyzed it through the lens of ethics and halakha.
Titled “Obamacare: The Enigma Unveiled,” the event began with a crash course in American medical history by Dr. Kevin O’Halloran, a senior resident at the Montefiore / Albert Einstein College of Medicine Department of Orthopedic Surgery who recently published a review article on Accountable Care Organizations (ACOs), a facet of PPACA. O’Halloran highlighted the factors that set the stage for health care reform in 2010, noting that more than 16 percent of the population was uninsured that year, private and public health care expenditures in the United States had totaled more than 15 percent of the country’s GDP, and America ranked seven out of seven developed countries for “quality, efficiency, access, equity and healthy lives” according to the Commonwealth Fund.
He compared the passage of PPACA to a “patch” being released for a “glitchy” computer program. “Obamacare doesn’t tear down any aspect of the American medical insurance now,” he said. “It builds on what we already have.”
Speaking about the bill’s influence on the insurance industry, physicians and the average American, O’Halloran discussed clauses that called for close regulation of insurance companies’ profits and services and expanded Medicaid eligibility for the poor. He also offered students a population-based breakdown, explaining how families, pregnant women and senior citizens would be affected.
As a doctor, O’Halloran addressed a concern that is especially important to medical school hopefuls: changing physician pay and hospital funding. He focused on value-based purchasing, one of 20 new payment systems and initiatives that Medicare will try out as part of PPACA and that could be emulated by private insurance companies. “What Medicare is looking to do is institute a policy that reimburses physicians based on a patient’s outcome and sees whether hospitals, doctors and rehab centers are doing their best to help patients improve in a timely and efficient way.” O’Halloran added that these value-based payments were designed to incentivize physicians and hospitals to make more thoughtful and more innovative decisions about patient care, but the impact on physician pay was still unclear and would vary by specialty.
Dr. Herb Leventer, adjunct instructor in philosophy at Yeshiva University, took on some of the more frequently circulated fears about PPACA, including arguments that its tax increases would choke America’s already struggling economy. “This is not a job killer—it’s going to fund another million jobs in health care, because if we’re going to have more people insured, we’re going to need to provide more health care,” Leventer said. He also noted that the purpose of PPACA was not only to extend coverage to the poor, but to enhance coverage for all Americans. “We do provide the best health care in the world, but we currently provide it only to those who have lots of money or good insurance. About half of our country has neither.
“In the United States we have two stereotypes about how to live,” Leventer added. “There’s the mythical cowboy, the rugged individual, versus the mythical small town, where everyone pitches in to rebuild the barn that’s just burned down because they all understand it could be them one day. Much of the debate on health care reform sounds like these two myths: individual autonomy versus social solidarity, competing for the soul of our country.”
From the perspective of Jewish tradition, Rabbi Yosef Blau, mashgiach ruchani [spiritual advisor] at YU-affiliated Rabbi Isaac Elchanan Theological Seminary, turned the discussion to a Talmudic conversation about private versus public charity. “There’s a balance between individual giving and what the community sets standards for,” he said. “Although the overwhelming majority of our books were written when preventative medical care wasn’t understood at all, the same way that halahka shows concern that everyone has a minimum amount of food to eat and clothing to wear, given the ability of society to provide medical care, it would similarly set some kind of requirement to ensure that everyone gets at least that minimal amount of medical care.”
The Yeshiva College Pre-Med Club, Stern College for Women Pre-Med Club, Pre-Dental Society, Pre-Pharmacy Club, Public Health Club, and the Stern College and Yeshiva College Student Councils also sponsored of the event.
According to Chani Herzig, a junior majoring in women’s health at Stern College for Women and one of the event organizers, the discussion was a much-needed breath of fresh air for students interested in the medical field but confused by contradictory rhetoric about PPACA. “This is something which is relevant, changing, and happening now, and people need to know,” she said. “Logistically, everything is changing—the way doctors are paid, the way they enter or don’t enter into practices, the way they choose specialties—and for many of us who are considering going into any part of the medical field, it’s critical that we know what we’re talking about.”