Straight talk on health care reform: Debate over repeal makes for lively TV, offers insights, different viewpoints

The Colorado Health Foundation sponsors the annual Colorado Health Symposium, one of the premier health care conferences in the country. The 30th edition was last month in Keystone, and one of the highlights was a debate on whether the Affordable Care Act should be repealed. It will be aired on Rocky Mountain PBS on Thursday at 9 p.m. (Channel 6 in Denver, Channel 8 in Colorado Springs-Pueblo, Channel 18 in Grand Junction and Channel 20 in Durango.)

The question is more provocative than practical, since repeal is not currently on the table (although that, of course, could change with the 2012 election). However, the discussion was interesting and worth summarizing.

First, we'll say that, in our opinion, the Affordable Care Act points the U.S. in the right direction. It represents a hard-fought and hard-won first step toward mending our costly and broken health care system. As with any product of political compromise, it is not ideal, but it should be protected, amended as needed and advanced. The more we argue about this or that detail, the more we lose sight of the greater value of this law and the more we depreciate it in the eyes of Americans.

Three of the four panelists opposed the Affordable Care Act – for widely different reasons.

T.R. Reid, author of The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care, argued that the current law doesn't go far enough. He advocated for universal care and suggested that the best way to achieve universal health care would be for the Supreme Court to rule the individual mandate provision of the ACA unconstitutional. If that were to happen, "politicians will be liberated to go back to a new plan and run on universal coverage." He argued that universal coverage would be a winning national political strategy.

Given the current political climate and the previous heated rhetoric aimed at the public option during the debate over the Affordable Care Act, it is difficult to accept the notion that such a system would fill the vacuum left by the demise of the ACA. A universal health care scheme represents a massive restructuring of our current system, and it would also require significant start-up costs. In addition, during the debate on the Affordable Care Act a public option was rejected by the Senate, which was controlled by Democrats. This clearly casts doubt upon the passage of a far more ambitious universal health care plan in the future.

Two other panelists were Jon Caldara of the Independence Institute and Grace Marie Turner president of the free-market Galen Institute. Caldara led a failed effort in 2010 to exempt Colorado from the Affordable Care Act, and Turner is the author of Why ObamaCare is Wrong for America.

Both supported a free-market approach to health care. In general, they feel that if people were to pay their providers directly for regular health care, they would spend the money more wisely because they would shop for the lowest prices. In response, providers would be forced to compete for patients and that would drive costs down. Insurance would only be used for high-risk and high-cost conditions.

That is a summary of a more complex argument and may not do justice to their notion of a free-market/market-based alternative. Regardless, implementing this plan would require an overhaul far more ambitious and potentially disruptive than the Affordable Care Act. The idea is also based upon a fundamental mischaracterization that the Affordable Care Act represents a government takeover of health care. In fact, it preserves and builds on the current private-sector-based system.

The lone panelist who supported the Affordable Care Act was Len Nichols, a health care economist and director of the Health Policy and Ethics program at George Mason University.

Nichols believes that the law can be amended and improved. But he has a more practical reason for supporting the Affordable Care Act: He said repeal would bring to a halt any health care reform because of the toxic political environment. No president, Democratic or Republican, would be willing to take on health care reform given the political downsides.

Nichols, in the debate, said, "This is it, sports fans. You hang on to this and you make it better. You make it as market friendly as I know it can be, or you give up."

We give Nichols the final word not simply because we share his opinion but because we believe he offers the most realistic outlook. We don't think universal coverage can advance politically, and a free-market overhaul is not practical and may not deliver the outcome it promises.

The Affordable Care Act is the law of the land. It is working. It can be improved. Let's build from here.