Americans pay more per capita for healthcare than anywhere in the world, but the outcomes are far from the best. And when it comes to improving the system, the only thing experts agree on is that its complicated. The Affordable Care Act is an attempt at comprehensive reform.
Bill Roper is head of the UNC Health Care system. He has spoken out in favor of Obamacare. He acknowledges there are downsides, but he says there is one undeniable benefit.:
One way we'll be better off is people that don't have health insurance now, for whom we get zero dollars, we'll have a means to pay for it.
Bill Roper knows healthcare as well as anyone. He's the Dean of the School of Medicine as well as leading UNC Health Care. He's worked on the insurer side, as senior vice president of Prudential HealthCare. He's also had federal positions, in the White House and as director of the Centers for Disease Control and Prevention.
He talked with WUNC's Frank Stasio. Here are some highlights from their conversation:
The top misunderstandings that Bill Roper sees in medicine:
- Everywhere you go you get high quality healthcare. ("That's just not true," Roper says.)
- Everybody ultimately gets the care they need. (Again, not true, he says.)
- We shouldn't worry about the cost of care. (It's not in our collective economic interest, he says.)
On the 50 million people who live in this country and don't have health insurance:
We pay a heavy price as a nation to the fact that no t everybody has access to healthcare in America. I know it's often said ... that we've got the world's finest healthcare system in America. The facts just are not that way. Yes we do have places in America that have the very best healthcare that the world can offer. One of which I am privileged to lead ... But on average the performance of the American healthcare system is not nearly as good as many other countries.
And you can't just look at what happens to the people at the top of society or in the best of institutions, it's also what happens in the bottom of society and at the worst of institutions. It should matter to all of us, not just because of our compassion for our fellow human beings, [but because] we pay a heavy economic price for our dysfunctional healthcare system.
On what he would have done differently if he had helped develop Obamacare:
I would have been much more focused on the cost of healthcare.
What the legislation tried to do primarily is cover the uninsured, which is a laudable goal to be sure. But it basically said, 'Let's cover the uninsured, and we'll figure out how to control the cost of care later.'
But if you stop and think what that really is saying, it's 'We're going to take the world's most expensive healthcare system, and make it a whole lot more expensive and figure out how to deal with it down the road.'
On North Carolina's controversial rejection of an expansion of the Medicaid program:
I tried to persuade the Legislature and the Governor to go a different way.
I do understand...they believed when making the decisions that there were so many problems with North Carolina's Medicaid program, that they just couldn't -- shouldn't -- expand it until they got those problems fixed. And that's a rational position.
But there's a countervailing argument that says 'This is an opportunity to to do something that we will be of benefit not only to the thousands of people who would then be enrolled in Medicaid, but it will assist doctors and hospitals (who are providing care for free now) so they can get some payment for it.'
And it would be an economic boost to our state at a time when we are still struggling to get out of the recession that we've been in.
I hope that in subsequent legislative session and beyond our state's leaders will revisit that issue.
On President Obama's now-famous statement about Obamacare, "If you like your healthcare plan, you can keep your healthcare plan."
I understand why he said it, but unfortunately it just isn't true, wasn't then, isn't now.
Practically everything about healthcare needs to change, from who delivers it, to how they are organized together, to how we finance it, to where it's provided. All those things.
We can't sneak up on the American people. We've got to have this kind of frank conversation with 301 million people and persuade them that it's in their interest long term to change.