Dr. Jonathan Gruber: Can we control costs in healthcare reform?

Harvard Law School

Harvard Law School rounded up a panel of experts to discuss some of the implications of healthcare reform in the 1st annual Health Law in Review panel discussion.

Jonathan Gruber, an MIT economist and a healthcare reform advisor to President Barack Obama, said that many of the cost control measure the Patient Protection & Affordable Care Act encourages, such as involving consumers in insurance price-point shopping or promoting provider reimbursement based on health behavior of the enrollees, come with "thorny legal issues."

"It’s important to be realistic about the fact that implementing this is not going to be easy," Gruber said. "It’s going to be a mess."

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"Social equilibrium" is going to be the most difficult hurdle – running a nationwide campaign, similar to what was seen in 2006 in Massachusetts, to make the individual mandate a widely accepted notion, Gruber said.

Einer Elhauge, Harvard Law School professor and former chairman of the president’s Antitrust Advisory Committee, also spoke at the event. He pointed to 2 ACA committees that might have major impacts on the way reform is implemented.
According to Elhauge, the Center for Medicaid & Medicare Innovation and the Independent Medicare Advisory Board may increasingly regulate firms’ interactions with physicians and assign a value to each treatment or procedure. Elhuage favors giving employers the ability attract enrollees with a separate risk-adjusted payment that must be spent on care for the entire group.

Elhauge also voiced his concern that there were not enough incentives for Accountable Care Organizations to coordinate.

"Preemption power of the broad sort is like CMI and IMAB; that’s where I see the ultimate promise, rather than in the ACO organizations," he explained.

Other panelists at the Health Law in Review discussion included Glenn Cohen (assistant professor at Harvard Law School and co-director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School); Holly Fernandez Lynch (executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics); Wendy Parmet (associate dean at Northeastern University School of Law); Renee Landers (law professor at Suffolk University Law School); Aaron Kesselheim (research associate, Dept. of Health Policy & Management, Harvard School of Public Health); and Kevin Outterson (Boston University associate professor of health law, bioethics and human rights). The event was held Feb. 1, 2013 at Harvard Law School.

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