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

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Dr. Lewis Goldfrank (center) discusses a patient with medical residents.
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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.