Economics, Tax Policy, and Health Care

 By Erica McKenzie

On November 11th and 12th, the Insurance Law Center, Connecticut Insurance Law Journal, and Connecticut Law Review presented a joint symposium on the legal and policy implications of health care reform and the Affordable Care Act (ACA). Pro Se sat down with UConn Law’s own Professor Stephen Utz, who presented on the tax policy considerations of the ACA, to discuss his impressions of his panel and the topic in general.

Professor Utz remarked that fellow panelists Professors Ted Ruger (University of Pennsylvania) and Rex Santerre (University of Connecticut School of Business) presented an overview of the “tough reality” implications of ACA. They reported that the cost containment measures do not seem realistic. The lack of coordination between various areas of the medical field creates inefficiency in the U.S. healthcare system.

Professor Utz explained that currently- doctors are practicing self-defensive medicine to protect against lawsuits. This involves ordering expensive, unnecessary, and duplicative tests. “There is too much treatment because no one is sitting down to figure out what patients actually need and coordinate the testing.”

During the discussion “the Mayo Clinic was held out an ideal” for how health care should operate. It follows an integrated care model for its patients, in which the doctors collaborate over patient treatment. Rather than having doctors re-order the same tests and examinations as the patient works his way through the treatment process, the doctors focus on coordinating the treatment and providing seamless integration of all levels of care.

While this integrated model certainly works well for Mayo, the principle underlying such treatment may not accord well with the U.S. conceptions of health care: “We see that as rationing health care.” Additionally, Professor Santerre explained during the panel that “it took decades for them [the Mayo Clinic doctors] to create the systems of trust that allowed them to integrate professionally.” The majority of health care providers practice defensive medicine, contrary to this collaborative method.

Professor Utz himself spoke on the interaction of the ACA with tax policy. He noted that one of the goals of our present system is to untangle individual health care payments and government benefits from the tax base, but that ACA only partly accomplishes that goal. “The ACA continues to exclude self-employed self-provided health insurance and large employer-provided heath care coverage from income, which accords with this goal, but it also continues to tax some or all of what employees without employer-provided health care pay for their coverage, while imposing a mandate that everyone buy insurance.” By continuing to apply exclusions, deductions, and credits unequally, ACA perpetuates inequality inherent in the current tax system.

In addition to the panel on the tax and economic considerations, the symposium included an examination of many of the controversies that have arisen as a result of ACA’s enactment as well as scrutiny of the different provisions of the Act itself including issues states face in implementing the Act, disparities in access to health care, and constitutional concerns. Overall, Professor Utz concluded that listeners sitting in on any of the panels would emerge with an improved understanding of the problems facing health care reform.

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