‘Obamacare’ architect speaks on economics, policy confusion
Jonathan Gruber, architect of the Affordable Care Act and a chief advisor to President Barack Obama, delivered the keynote speech for the GlobeMed at Wash U Hilltop conference on Oct. 4 using economic reasoning to break down health care reform into its key rationales.
Gruber discussed how the single most important concept of the law is that the United States is the only industrialized nation in the world in which someone could face bankruptcy as a result of genetics or a traffic accident.
His highly anticipated presentation drew a crowd of more than 350 people. By the start of the Friday afternoon speech, Brown 100 was filled to capacity—people began to sit in the aisles and stand in the back of the room, and several were turned away.
The address was open to the public, attracting members of the University community in addition to students from other universities and health care industry employees.
Gruber prefaced his speech by acknowledging that he could not speak objectively on the subject.
“I have to raise my hand [and] say that I am probably the single most biased person in the world to talk about this—I helped write the law and was on the board that implemented the law,” Gruber said.
Gruber discussed the historical context of health care reform, noting that the U.S. government has attempted reforms about once every 18 years since Theodore Roosevelt’s presidency. He mentioned that previous reform attempts failed due to the split sides of the argument and the size and influence of the health insurance industry.
He also recounted his experience designing the health care system for former Massachusetts Governor Mitt Romney. Gruber pointed out three main reasons why he believed “Romneycare” worked: it covered two-thirds of the previously uninsured, it fixed the insurance market causing premiums to fall 50 percent, and there was widespread public support.
“The Affordable Care Act, as one of my friends described it, is Romney’s plan with three more zeros. It’s basically a national version of what we did in Massachusetts,” Gruber said.
Gruber pointed out that the inherent uncertainty within the politics of health care reform makes any reform difficult to implement.
“We do not know how to fundamentally control the growth of the health care costs in the U.S. without risking the health of our citizens,” Gruber said. “It’s much harder to know what will be efficient and what will be wasteful…even if we knew how to control health care costs, the politicians wouldn’t let us.”
After Gruber concluded his presentation, there was time allotted for questions from the audience. Several physicians and medical students voiced their concerns about compensation for health care providers and the aspect of paying for quality versus quantity of care. Gruber responded that health care costs have gotten out of hand with overspecialization.
Julia Belsky, a first-year graduate student in the Brown School of Social Work attended the event and was pleased to see its high turnout.
“It was really reassuring and exciting to see so many students there and so interested and riveted by the speaker,” Belsky said. “It restored my faith in Wash. U. students being able to be more educated and more engaged in their country when they leave Wash. U. and become professionals in their field.”
Gruber concluded the address by saying that the inherent complications of health care reform require patience.
“At the end of the day, we don’t know what works. We have lots of great ideas, but we don’t have the means to support them,” Gruber said. “So we need to be humble, and we need to be patient—humble in understanding that we don’t know what works, patient in understanding that we have plenty of time to get there.”