What Makes Health Care Such a Divisive Issue

Tuesday, March 04, 2014

Dr. Ezekiel J. Emanuel explains how the Affordable Care Act reforms are reshaping the health care system. He also looks at why health care in America has become such a divisive social issue and why reform has bedeviled presidents of the left and right for more than a century. Dr. Emanuel is a professor of medical ethics and health policy at the University of Pennsylvania and served as a special adviser to the White House on health care reform. He’s the author of  Reinventing American Healthcare: How the Affordable Care Act Will Improve Our Terribly Complex. Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.


Ezekiel Emanuel

Comments [22]


My "affordable" health insurance

1) 20% more per year in cost than my old "un-affordable" health insurance

2) Can only use in-network doctors. My old "un-affordable" health insurance paid 70% of the out-of-network doctors' bills.

3) Will NOT cover cost of prescriptions written by my out-of-network doctors, even though the contracts are with the pharmacies and NOT the out-of-network doctors (or in-network doctors, for that matter).

Mar. 05 2014 12:55 AM
Technite from Central NJ

This was the most cogent discussion of the ACA I have ever heard. Mr. Emanuel had facts to back his statements and realistic explanations on why decisions were made. I was riveted for the entire segment.

Mar. 04 2014 03:29 PM

@Ivan Obregon from NYC

Well said...

Mar. 04 2014 03:02 PM
George from New Jersey

Unfortunately, people make pronouncements or judgments from their personal experience, at a very early period in the Affordable Care Act implementation.
Very similar negative forebodings were stated about the Social Security Act, and the Medicare Act. A decade later, however, there was no mention of the doom and gloom, which never materialized. Dr. Emanuel is a health care policy authority, and clearly and objectively states the facts as they are without having them be politicized.

Mar. 04 2014 03:00 PM

@Joe Mirsky,

In the past, not matter if you where Low, Middle or Upper Income Class, Medical bills could outstrip all of your financial resourcess... that's why Medical Bankruptcy was the #1 cause for bankruptcy in the US... Unless you where FILTHY rich and did not nead health insurance... no matter what insurance you had in the past.. there was always an "annual" and "Lifetime" cap in your policy... not to mention the "pre-existing" exclusion clause... So upper middle class families with a child that was born with a congenital "lifetime" medical condition would eventually outstrip all of the families finances.... Today, under OBAMACARE, that should never happen again.

Mar. 04 2014 02:59 PM


Once the ACA is fully implemented and operational (this might take a few years) medical information and diagnostics will be state of the art and available to physicians and hospitals which will reduce complexity and increase accuracy astronomically.. it just takes time to get there.. but, you have to start somewhere.

Today, the 'ability to pay' is the driving force for not only the "quality" of medical care.. but even medical care period... Citizens at the lower end (4 times the poverty level) are now able to get "adequate" medical care which they never had before.. that is a START... For Americans to have "equal access" to the health care we must have "Government Health Care" like the Veterans Administration.. The "quality" of that kind of care is debateable.. But, around the world, even countries with so called "socialized medicine" have higher quality of care for the wealthy (with additional top notch insurance or unlimited funds for the BEST care available)... No matter what political system you have MONEY will always go after and receive the BEST that's available... e.g... Organ Receipent Lists where bypassed by Yakuza bosses to the top of the list for an organ with FBI assistance.

Mar. 04 2014 02:54 PM

Ed from Larchmont

You should listen to this discussion and you will then understand how BAD our health care system was. The only reason it became "political" is because it was so bad. If it actually worked nobody would be trying to fix it.

Before abortion was "legalized", our country still had many abortions however many or most of them had very damaging effects to the "mothers" health or life. If you want to "stop" or "prevent" abortions then you must stop or prevent unwanted pregnancies... The only solution you can propose it seems is "abstinance".. and with what kind of results? Those states that have "outlawed" abortion and only teach abstinance have had a dramatic rise in "teenage pregnancies".. many of which still end up in abortions or 'unwanted' children.

Obamacare does not pay for abortions but it does offer "free" birth control which is still the BEST solution for preventing abortions.

Mar. 04 2014 02:43 PM
KZ from New Jersey

Emmanuel is an apologist for the bloated system we have. Why doesn't he talk about the unrestricted cost in the system? Insurance does nothing to stop the costs from spiraling and the networks becoming narrower.

I spent the morning trying to figure out how to get my asthma medicine. I have a silver national access plan I bought on the exchange and my albuterol inhalter costs $70 because of the sleazy pharma industry. I learned that I can get it for 1/3 of the price by ordering from Canada.

What good is it to be covered by insurance when the costs are still prohibitive?

Mar. 04 2014 02:02 PM
resident alien from Williamsburg

while a single payer system might not be ideologically possible in the US, there is the law of large numbers. the more people are insured by the same plan, the more efficient, the smaller the risk and therefore the lower the insurance rate.

Haveing hundreds of insurance companies (that don't necessarily compete in all markets.btw, why have not just 1 market?) with thousands of different plans is not efficient! It just create confusion and obfuscates price and feature comparison! Having 5 competing insurance companies with 20 different plans is more than sufficient, even for a country as big as the US..

Mar. 04 2014 01:58 PM
Amy from Manhattan

And the "rationing" the US has had (before PPACA) was imposed by the insurance co's., not the gov't.

Mar. 04 2014 01:53 PM
Wayne Johnson Ph.D. from Bk

The poor are doing much worse at the "exchanges" and paying proportionally more.

Mar. 04 2014 01:50 PM
KZ from New Jersey

"We aren't going to get rid of insurance companies."

This is why I don't think anyone should listen to Ezekiel Emmanuel. He is part of the problem.

Mar. 04 2014 01:46 PM
hmi from Park Slope

Why do they keep repeating this oft-repudiated stupidity about Obamacare being an invention of the Heritage Foundation?

Among others, here's the guy who wrote the original Heritage plan, Stuart Butler:
" the version of the health insurance mandate Heritage and I supported in the 1990s had three critical features. First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on "catastrophic" costs — so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.
Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.
And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the "mandate" was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement."

Mar. 04 2014 01:42 PM
Vlad from Matawan, NJ

Here is the ACTUAL INFANT MORTALITY data by State/Race...

Mar. 04 2014 01:42 PM
ann from ny

I disagree that Affordable Care Act improves quality of care. I live in NYC. The chose of doctors in any of the plans is ridiculously limited. Is Mr. Emanuel enrolled in this program? Does he know anyone who voted for the plan or who designed the plan enrolled in this program?

The Democrats should have held out for something closer to a single payer. While politicians will say the Americans are too independent minded and would not go for single payer plan, that is not true. Evidence of this is the success of Medicare. Sadly, both the Democrats and the Republicans are in the pockets of the insurance companies and the Affordable Care program is primarily a huge gift to the insurance companies.

Mar. 04 2014 01:40 PM
Charles from Tribeca

Follow the anti ACA money. Americans For Prosperity, Heritage Foundation and Cato Institute are funded by billionaires. Why don't billionaires want affordable health care for the middle class?

Mar. 04 2014 01:40 PM
ivan obregon from nyc

What a simplistic definition of "socialism" Dr. Emanuel provides as if the european socialist democracies don't also include diverse forms towards healthcare, taxes, and income distribution including market incentives and other options in their mixed-economy model: Medicare/medicaid is a socialist model, too, it's not just the British NHS,and the most American socialist, Michael Harrington, thought they were, too. Some always need to find the worst examples to denounce any association with the word socialist so it's surprising he didn't invoke North Korea instead. The rest of what he's said has been interesting, though, and provocative...

Mar. 04 2014 01:40 PM
Vlad from Matawan, NJ

Why is our "infant mortality" so poor compared to other countries?

The answer is simple when you look at the data...

When you look at infant mortality by state and by race... The "white" population in the states with the "highest" infant mortality still have a mortality rate lower than the "black" population in any of the 50 states.

Mar. 04 2014 01:29 PM
Joe from nearby

Please address "Ed from Larchmont's" comment about the ACA & abortion.

I've heard so many conflicting takes on the subject that I don't know what to believe anymore.

Mar. 04 2014 01:25 PM
Joe Mirsky from Pompton Lakes NJ

It's not new.

“In the middle income class, a family may suddenly be stricken with a major illness, be staggered by a sickness bill of $200, $500 or more which may throw its modest budget out of line for years.”

“At the moment, the whole subject of health insurance is highly controversial, is amazingly complicated by confusions, contradictions, disagreements, name-calling, internecine schisms and political jockeying.”
— The Literary Digest January 30, 1937

Mar. 04 2014 12:26 PM

How will the ACA make the system less:

-terribly complex and grossly inefficient: when it adds more layers to a complex system?

-blatantly unjust: when there are several plans of varying quality which depend on ability to pay?

-outrageously expensive: when it is a regressive tax which goes to for-profit companies?

All of these would be addressed by a single-payer system, not an insurance company bail-out/corporate boondoggle.

Mar. 04 2014 09:44 AM
Ed from Larchmont

One reason health care is so divisive is because it is centered around the issue that divides our society: abortion. Not only divisive, explosive. We made abortion part of our health care system ... so God is going to destroy our health care system, which was very, very good.
(It's also divisive because it involves so much money. And because it is an expression of a division of political philosophy.)

Mar. 04 2014 09:18 AM

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