The health care law's legacy

Even if the Affordable Care Act is thrown out by the Supreme Court, some changes spurred by the law are here to stay

Timothy and David Jost.

Kai Ryssdal: Unless the justices are doing a huuuuuuge constitutional head-fake, Thursday's going to be health care day. But it turns out that whether the Supreme Court tosses the whole Affordable Care Act, upholds the whole thing, or does something in between, some of the changes it brought to American health care are here to stay.

From New Hampshire Public Radio, Dan Gorenstein reports.


Dan Gorenstein: Three years ago, David Jost was playing wiffle ball. He slid awkwardly on his left ankle. He thought, hmm, sprained ankle. Turned out it was much worse.

David Jost: My left ankle never stopped hurting. Then some months later, my wrists started hurting. Then months later, my shoulders started hurting. Then my knees and then my hips and my ankles again, even more. Yep, it's done pretty much a full circle around my body.

David and his parents saw all the local specialists -- neurologists, orthopedists, chiropractors, an acupuncturist. Nobody had answers.

Jost: It's really scary having something that just gets worse and worse and doctors can't figure out.

So the family traveled 350 miles north to the Cleveland Clinic, four different times. There, David's dad, Timothy, says they saw something they hadn't seen in a year's worth of doctor visits back home in Virginia.

Timothy Jost: Every doctor knew what the other doctors had done. He didn't have to go over everything all over again.

Timothy Jost is not just a concerned father. The Washington and Lee law professor is one of the nation's top health experts. He's worked with the Obama administration to roll out the Affordable Care Act. And he thinks what his son experienced in Cleveland, is the future for the rest of us -- no matter what happens to the health care law.

Timothy: It's a really different model of the health care system. And I think one of the hopes is that we will be able to focus more on the patient and less on generating as many procedures and tests as one can.

At the clinic, doctors work together so patients aren't tested and retested for the same problem, electronic records keep information flowing, and that cuts costs and frustration. It's all about efficiency. This kind of approach, which led to David Jost's diagnosis of celiac disease, is catching on across the country. And Dartmouth-Hitchcock Hospital in New Hampshire is one of the trailblazers.

Jim Weinstein: There's a picture on my wall right here, it's a cover of a New Yorker magazine.

Dartmouth-Hitchcock President Jim Weinstein shows me the painting; it's a glass of orange juice, about half full. I've missed the point, says Weinstein.

Weinstein: It isn't half full or half empty. It's the wrong glass. And right now we have the wrong glass for health care.

That's Weinstein's way of saying the $3 trillion health care system is broken. That the system is set up to reward more care rather than better care.

Weinstein: We could make a lot more money doing a lot more spine surgery. I am a spine surgeon. That's not where we want to be.

The federal government and some private insurers are inclined to agree. They've signed contracts and started pilot programs with hospitals like Dartmouth to pay doctors for improved health of their patients, rather than the number of procedures performed.

Weinstein: The current system and/or systems have failed. We are going to create the future, not wait for the future to happen.

Most health experts agree -- making medicine more efficient and less costly is important, but these ideas on their own aren't enough to rescue the health care system.

Michael Cannon is a health policy analyst with the conservative Cato Institute.

Michael Cannon: Every few years people come up with a new buzzword -- a new way that we are going to finally reduce the cost of health care or improve the quality of health care. But really none of these ideas, none of these ways of financing or delivering health care, is a silver bullet.

Cannon is hoping the entire Affordable Care Act will be thrown out by the Supreme Court on Thursday. But even if it is, many of the changes encouraged by the law are here to stay.

I'm Dan Gorenstein for Marketplace.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

Timothy and David Jost.

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