The United States spends some 18 percent of its Gross Domestic Product on health care, more than any other developed nation in the world, but U.S. health outcomes do not match the expenditures, even in light of the federal Patient Protection and Affordable Care Act (PPACA), panelists agreed May 2 in Malott Hall.

Four panelists debated the merits of PPACA as part of the third annual "Sick in America" series on health care, organized by the Cornell Undergraduate Health Cooperative.

The PPACA was signed into law in March 2010 but is being challenged in federal courts. The U.S. Supreme Court could review this law as early as the end of 2011 or the beginning of 2012.

William White, director of Cornell's Sloan Program in Health Administration, explained that the PPACA requires most citizens to obtain private health insurance while allowing poorer individuals access to a state-based subsidy system. He noted that employers who "dump" eligible employees into the system are penalized. The statute, he said, also calls for expanding the Medicaid system -- which, he explained, is a "state-federal partnership where the individual states administer their programs," not a national program like Medicare.

"It's basically focused on access -- it's not trying to deal with cost," White said. "But in fact, there's a lot [about] cost and quality in the act."

Oliver Fein, M.D., professor of clinical public health at Weill Cornell Medical College, called the PPACA, "an act for the preservation of private health insurance." He noted that the initial version of the statute, which had a large public option that would have allowed 119 million people to enroll, was "massively scaled back"; its final version allows only 6 million people to enroll in the public option.

"[PPACA] mandates that you have to buy a product, namely private health insurance, that I think [is] a highly defective product," he said. "The private health insurance industry needed something to push people into it."

While all the panelists expressed various discontents with PPACA, panelist Roger Battistella, professor emeritus of health policy and management in the Sloan program, urged a move away from the "utopian dream" of a single-tier system. Rather, he said, people who can afford private health insurance should obtain it, and a voucher system should be put into place where people can choose their options, ranging from unrestricted programs to managed care.

"Over a period of time, [people] will move incrementally to some type of managed care, which is the ultimate goal of health care reform, regardless of which proposal you look at," he said.

Sinan Unur, Ph.D. '99, a medical services consultant, dissented somewhat, citing a rise in longevity as part of the reason for increased health care costs and pointing out that in a market-based economy like the United States, a person's ability to purchase a commodity that he or she can afford should not be limited by mandates and provisions.

"Honestly, I do not know which versions of these realities will be enacted," he said. "But I do support wholeheartedly the notion that people should have money with which to choose services."

The panelists agreed, however, that the government should somehow provide coverage for those who cannot provide for themselves.

Battistella added, "A creative partnership between the public sector and the private sector offers the most promising way [of] providing universal coverage at a cost the nation can bear."

Olivia Fecteau '11 is a writer intern for the Cornell Chronicle.