State and UI experts discuss healthcare reform


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Mariannette Miller-Meeks, the director of the Iowa Department of Public Health, said one of the main concerns in the debate over health-care reform was the expense of implementing policies, in addition to the overall cost of health care in the U.S. today.

"Becuse I'm a Republican, I'm going to say it's not that the Republicans don't think that health care is a problem — they do," the director said. "What they're concerned about is cost and choice."

Miller-Meeks joined two University of Iowa faculty members Wednesday evening to provide a comprehensive view of health care in Iowa and the Affordable Care Act. Colin Gordon, a UI history professor originally from Canada, and UI Public Policy Director Peter Damiano joined Miller-Meeks to discuss the debate in the Supreme Court on the Constitutionality of the Affordable Care Act's individual mandate.

Each speculated as to how likely it was the individual mandate segment of the Affordable Care Act — a policy requiring everyone who is uninsured to acquire health insurance — would be passed.

"To make people do something is never a winner politically," Damiano said. "I don't think health care is a big political winner. I think it's just a really tough one."

Miller-Meeks agreed.

"There are some who would say Justice [Anthony] Kennedy's comments that means it's going to be overturned," Miller-Meeks said, referring to the Supreme Court justice's concern about the role of the government and the citizen. "I can interpret those comments from the judges in a variety of ways. I think it's 50-50."

Panel members answered questions as to why American health care is comparatively more expensive than other countries.

Damiano said the United States spends almost $3 trillion a year on health care, partly as a result of an overwhelming majority of specialists in comparison to general-care physicians.

"The specialists are the ones that drive the costs," he said.

Gordon said he thought U.S. hospital care could be frivolous compared to his background with the Canadian public health-care system and cited his own experience with the birth of his son.

"The bottom line was there was good care," Gordon said. "[My wife] was safe, but no frills."

Damiano said the emergency-room visits and similar incidents that drive up the costs, rather than any excessive work done by doctors.

"I think that's, to me, is a real challenge. Of that $3 trillion, those errant physician visits aren't where we're spending our money," Damiano said. "It's the kinds of really big ticket stuff that is."

But, Miller-Meeks said, Iowa has relatively low health-care costs in comparison with other states — though Iowa has borne the costs of mandated parent coverage for youth even before national health-care reform.

She credited the doctor-patient interaction as a key point in maintaining low costs.

"Most physicians in Iowa have this discussion back and forth," she said. "If you present options to patients, almost always patients take the most conservative of options."

Damiano said an emphasis on equal points of view was stressed throughout the panel, which he thought was adequately balanced.

"I thought the political discourse was at the perfect level. Everyone is not going to necessarily agree on these issues, but it was done based on much as fact as you can, and based as much on experience as you can. It obviously didn't get personal, and that's exactly what we wanted," he said.

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