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Debate: Should the ACA be Repealed or Restructured?


You've seen Trump vs Clinton. The Pearls podcast looks at another debate: Should the Affordable Care Act be repealed or not?

Welcome to the latest edition of the Physicians Practice Pearls Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at editor@physicianspractice.com.


This week we present a supersized version of the podcast. We were inspired by last night's showdown between presidential candidates, Hillary Clinton and Donald Trump and decided to offer our own debate.

This year's Great American Physician Survey exemplified the split that divides doctors on the Affordable Care Act (ACA). Forty-seven percent of respondents say the ACA has done a great disservice to Americans; 45.5 percent said it has been mostly good, but not all good; and the remaining group say it's been great for all Americans.

Many physicians are indeed, frustrated with the health law, but have different views on what should be done with it. Some, like Paul Norwood, an endocrinologist out of Fresno, Calif., are of the belief that it's beyond repair. He says it should be repealed and replaced. Others, like Arvin Nanda, a family medicine physician at a three-doc practice in Dayton, Ohio, don't believe that would be an effective strategy to improve healthcare. Nanda is in favor of restructuring the ACA.

Norwood and Nanda joined us to debate the efficacy of the ACA and whether or not it can be salvaged. The two doctors both got a chance to give two-minute answers to four questions and then a one minute response to the other's initial answer. Below are a few highlights from the debate, which can be listened in its entirety above.

Question 1:Make your case, should the ACA  be repealed and replaced or should it just be restructured?

Dr. Nanda: "The ACA should be restructured. Repealing the ACA would cost taxpayers millions of dollars, insurers tons of money, and lots of practices lots of money. We've had 11 to 20 million people get insurance through the ACA, all of a sudden a repeal would leave those people without insurance whatsoever and create quite a quandary for them."

Dr. Norwood: "The ACA should be repealed and replaced. Presently, this country is in dire straits with a $19 trillion debt…the entire medical system, I'd say, has to be replaced. The ACA is an extension of our medical system. The medical system is highly regulated and this is another regulation that is unaffordable…the entire economy can't afford the expense of the ACA and the entire medical system."

Dr. Nanda: "I don't think the regulation is the issue. I think we agree on the competition, there needs to be more competition to lower costs."

Question 2: There have been benefits to the ACA - true or false. Explain your answer.

Dr. Norwood: "There have been benefits to the ACA....50 percent of the people are coming to my office from the ACA that have significant problems with mental illness that have not been previously treated."

Dr. Nanda: "That's a definite true…11 to 20 million more Americans have health insurance because of it, free contraception for employees in certain health plans, Medicaid eligibility has expanded in 26 states...another benefit is there are no annual or lifetime limits on healthcare. There are reasons for regulations at times, health insurance is only concerned with profit, not the care of the patient."

Dr. Norwood: "The main difference between he and I is he believes in a nanny state where the government has to take care of the people, I believe each person should have their own responsibility to take care of themselves."

Dr. Nanda: "He says on the one hand, insurance companies are leaving [the ACA], which they are, but then you look at statistics that say the CEO of UnitedHealthcare made $100 million last year. How much care was denied by that CEO so he could make the $100 million? To say they are hurting and moving out, I think, is a falsehood."

Question 3: Who is mostly at fault for the ACA's biggest problems - the insurance industry, the Obama administration, Congress, or another stakeholder altogether?

Dr. Norwood: "The underlining problem is the system in place is overregulated and over-subsidized."

Dr. Nanda: "Congress has not done what they should do. In a country where 11 percent of Americans favor communism and 9 percent are in favor of the job Congress is doing, I'd say Congress is most at fault."

Question 4:What's the best system to fix the healthcare problems of this country?

Dr. Norwood: "There are two ways to fix the system. The socialist way, which is the way I fear we are going…because of overregulation and government interference the cost of care becomes so astronomical, the government just takes it over. The best system…de-regulate the system, make it capitalistic, where people pay their own bills."

Dr. Nanda: "I don't like the idea of more government intervention and regulation, but what we see in the marketplace, companies are not working in Americans' best interest…One way of doing things is tax the heck out of [junk food] products and use that money to go back into healthcare. If someone is going to buy a Coke, it should cost five dollars instead of 50 cents....I know Dr. Norwood will disagree with that. We should have a discussion on what basic insurance rights are for every American…we can cover basic insurance rights and then have people pay for everything else."

Dr. Norwood: "Of course, I don't believe in raising taxes. Charging for Coke or marijuana would just steal money from other people and put it into a bloated system."

If you have any ideas for future podcast debates, let us know commenting below or by tweeting us at @PhysiciansPract

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