Supreme Court Ruling a Significant Step to Improving Health in America

Editor's note: This story was updated at 12:30 p.m.

Experts at UCSF say the historic U.S. Supreme Court ruling on President Obama’s health care law has the potential to significantly improve the health of the nation and the education of future health professionals.

“To me, this is symbolic of our nation’s commitment to become a more moral and just society,” said Claire Brindis, DrPH, director of the Philip R. Lee Institute for Health Policy Studies. “It’s monumental in its potential to make significant inroads to improve the health and well-being of every American.”

The 5-to-4 ruling, with Chief Justice John Roberts writing the majority opinion, upholds the Patient Protection and Affordable Care Act, considered President Obama’s key domestic legislation. Even its most contentious piece, the individual mandate, was upheld.

For Brindis, who says she’s been “on pins and needles” awaiting the high court’s ruling, the decision is a vindication of a century-long struggle to ensure that health care is affordable and accessible to all Americans.

“The lack of health coverage for nearly 50 million Americans has always been a black mark on this country and this historic legislation provides us with a platform to really make significant inroads in reversing this immoral stand.”

Brindis, who will be making media appearances for her expert reaction throughout the day, said this is a great day in America.

“This is an historic moment that we will remember for decades because the health care law has so many tentacles and touches every American,” she said.

As news of the ruling spreads across UCSF, faculty are reflecting on how it will affect their work providing health care and teaching the next generation of health professionals.

Rethinking Health Sciences Education and Training

“I think it’s a great step forward for health care in this country,” Molly Cooke, MD, director of education for Global Health Sciences. “As an educator, it’s really difficult to do high quality clinical education in a dysfunctional care setting. Anything we can do to make care-delivery better, more accessible and more equitable rebounds to the benefit of education.”

“Students and residents — good and idealistic people — have a hard time when they see that some patients can get services within the system that they really need while others can’t. That doesn’t make sense to our learners.”

Catherine Lucey, MD, vice dean of education for the UCSF School of Medicine, says the ruling is good news for many young UCSF students who are paying hefty bills. They will be better and more affordably insured as a result of the law. And it will mean rethinking health sciences education and training.

“As an educator, practicing internist and geriatrician, I am thrilled to see the Supreme Court’s decision go the way that it did,” Lucey said. “Many of the provisions in the Affordable Care Act were specifically designed to improve training, and it includes much of the funding for primary-care training. But all of our trainees, regardless of the fields they work in, should benefit from work that will be performed by the Patient Centered Outcomes Research Institute, which was developed through the act to improve medicine by developing evidence to determine which practices really work. This should enable us to continually improve the care that we deliver, based on evidence, not anecdote.”

“The act also really challenges us as educational institutions in a positive way," Lucey said. "More than 30 million people are going to be added to the health care rolls, and that means that we are going to continually strive to be able to provide reliably high-quality, patient centered, effective, efficient care to a much larger number of individuals. As educators, we have to rethink how we train our health professionals — physicians, nurses, pharmacists, dentists, social workers — to ensure that they are capable of providing care to this expanded population in a way that doesn’t break the bank.” 

While the ruling and its projected impact on health delivery and financing will be key dividing points among Democrats and Republicans heading into the presidential election, the fate of the law may utlimately be determined by those who control the White House and the Congress in 2013.

“The impact of today’s Supreme Court decision has been felt worldwide," said John Maa, MD, a surgeon and health reform advocate who spent time in Washington, D.C. in the months following passage of the 2010 law. "But it's not over yet. A symbolic House vote the week of July 9th to repeal the [law] was announced by Majority Leader Eric Cantor shortly after the decision was released. The war on Capitol Hill over health care reform has erupted once again.

As our nation moves forward in this debate, hopefully our elected officials will succeed in rising above the acrimony witnessed in the past, and focus upon the larger needs of society. A balanced approach grounded in the central principles of fairness, equality, and justice will be key to transforming the American health care delivery system to achieve the important goals of quality, efficiency and safety.”   

Reforming Health Care: A Work in Progress

Brindis says that this is just the beginning of the law’s implementation, with the last provisions taking effect in 2014.

“It’s time to roll up our sleeves. We have a lot of work to do ahead to be sure that all the components of this visionary law is fully implemented,” she said. “This law shows a deep commitment to prevention which will hopefully make a significant impact not just for individuals but for society as whole.”

Brindis and policy experts across UCSF and beyond will work to evaluate the effectiveness of the health care law as they’ve been doing in California, which has been at the forefront of the implementation of health care reform.

“Our faculty will work on the state and national level to monitor its quality and reach of its implementation,” she said. “This is really a learning laboratory and we will have to make adjustments that are thoughtful and evidence-based. As the decision has just emerged, we need to better study the repercussions related to the state-level Medicaid expansions and the role that states will play.”

This ongoing work will be in partnership with leaders in government, public health, business and community members.

Brindis says incorporating more preventive measures is key to driving down costs and improving health over the long run. “Prevention is really at the cornerstone of health care reform.”

Jeffrey Norris contributed to this report.