SCOTUS ACA Ruling Point/Counterpoint: It Was the Wrong Decision

By Mark Lyles, MD

The ruling is clear: The federal government has the authority to require its citizens to spend their after-tax monies to purchase health care insurance. Although I disagree with the ruling, I think it presents the country with the opportunity—and imperative—to begin the process of implementing true health care reform.

I know. It sounds funny, doesn’t it: “Begin the process”? The country has been under significant “storm and stress” the past couple of years; now the Supreme Court says the ACA is the law of the land. The case should be settled, right? Yet, most will agree that the ACA was focused primarily on health insurance reform, not true health care reform. Now that the Supreme Court has ruled, our elected officials must seize this opportunity to move forward and address the obvious: The American health care system is still broken and we still need to make significant changes to fix it.

While I don’t think filing a slew of new lawsuits is in the best interest of the country, this is what will happen. Efforts to repeal and replace ACA will continue. With national elections looming, the refrain will get louder and louder.

In the fray of these polarized arguments, it will be increasingly important to consider the topic of collaboration. Both parties must work together to implement the laudable aspects of the ACA that are patient-centered AND market-based: insurance pools for Americans who have pre-existing conditions and practices that allow those under 26 years of age to remain on their parents’ insurance policies. These aspects of ACA make economic sense.

Congress must also work to refine health care entitlements in ways that will preserve not only our Medicare and Medicaid programs but our country itself. As we are seeing in such countries as Greece, Spain, and Portugal, overpromising and underfunding entitlements on a national scale have significant consequences that eventually will be realized.

The United States’ preference for defined-benefit–based health insurance coverage is simply unsustainable. In order to engage consumers and align incentives among providers and payers, we must explore defined-contribution insurance models that will encourage patients to make value-based decisions when spending their own health care dollars.

Such defined-contribution plans eventually must become the model for paying for medical care for both private- and public-sector beneficiaries. Rather than creating an ever-expanding list of covered services and benefits, beneficiaries would make value-based decisions regarding what is best for them. Consumer demand will then result in price transparency and downward pressures that will combine to reduce overall health care costs. With these new financial incentives in place, a true market economy can be realized in health care.

—Mark Lyles, MD, is Chief Strategic Officer at the Medical University of South Carolina. He can be reached at 

0 thoughts on “SCOTUS ACA Ruling Point/Counterpoint: It Was the Wrong Decision

  1. This comment is a ridiculous and unfortunate continuation of the “patient as informed customer” concept of how to sort through the problems of organizing and delivering care to those who have coverage but either use it badly (demand things that are not in their best interests) or whose physicians and wallets use it badly (wallet biopsy as a precondition for care). The problem that the ACA is trying to address, and there are many, is that without everyone in the mix, rational care of communities that is both cost effective and of high quality is impossible. You don’t water your plants with a bucket full of holes. It is disheartening to read of an academic health center leader who still espouses the marketing and market concept as worthwhile. “Defined contribution” is just another term for saying “sorry, you spent your money poorly” which turns blame and responsibility to the public and has physicians absolve ourselves of any responsibility for the mess we are in or leadership to change it. I won’t even go into issues of health care illiteracy that affects almost everyone and most particularly those whose problems and challenges are at the heart of disparities. How can you “choose” if you don’t even understand what the menu is?

  2. This article does not make clear why the SCOTUS ACA ruling was the wrong decision. It defines ACA as health insurance reform, warns of looming lawsuits, and presents the author’s perspective on true health care reform. But the question still remains: Why was the ruling the wrong decision?

    Is the message that the SCOTUS ruling will lead to a series of distractions that would hinder true reform? What would have been better if the ruling had gone another way?

    This article is interesting but ultimately does not live up to the weighty title.