U.S. lawmakers are taking the wrong approach to health care reform, according to Dr. Nick Yphantides, the chief medical officer for the San Diego County Health and Human Services Agency.
Instead of focusing on expanding medical coverage to the uninsured and others in need, lawmakers should first be working on ways to improve the quality of care currently available and develop programs that modify human behavior.
"In many ways, we are just glorified janitors," Yphantides said, referring to himself and his fellow doctors, "because we're spending the vast majority of our time and resources – our talents, our treasures – cleaning up after unhealthy human behavior.
"We need better plumbers in America. We need better opportunities to prevent the spills from happening in the first place."
Yphantides was speaking as part of a panel discussion recently at the University of California, San Diego on the Patient Protection and Affordable Care Act – President Barack Obama's controversial legislation that has come under legal attack. The U.S. Supreme Court is currently debating the constitutionality of certain provisions and is expected to release its ruling sometime in June.
Yphantides said the nation's problems are evidenced in a recent study by Cornell University that stated 21 percent of America's ballooning health care expenditures can be attributed to obesity. He also noted that 5 percent of Americans account for 50 percent of the country's health care costs.
Yphantides, who admitted to dropping more than 250 pounds and seven medications since graduating from medical school 20 years ago, said better eating habits and lifestyle choices are key to reforming the health care system.
"I think at the core of our dilemma is that we are dealing with the reality that we do not have a health care system in this country so much as we have a sick care system," he said.
San Diego County is doing its part to promote healthy living with a series of initiatives, so it can be a model community where "true health service delivery reform is happening," Yphantides said. He said San Diego, with its reputation for encouraging innovation, is the perfect place to lead the way for change.
While he believes the individual mandate portion of the health care reform bill will be struck down, Yphantides said it will represent a "tremendous opportunity" to take a cold, hard look at how Americans pay for health coverage and what the return on investment is.
Dr. Julianne Howell, a health policy consultant and UCSD's former director of health sciences planning, agreed that the delivery of health care is the most important piece of the Affordable Care Act, and that is can be easily separated from the individual mandate provision if that part of the bill is found unconstitutional.
"The financing is important, and that's where the insurance comes in, but (what is) equally important (is) giving you value and quality to have a fruitful life," she said.
Glenn Smith, a constitutional law professor at California Western School of Law, said the justices have a "bewildering" number of options to consider, from keeping the entire bill intact to throwing it all out.
"The choice we're likely to end up with may be the lowest common denominator – a choice that a majority of justices can agree on rather than the best choice available," he said. "That shows you the downside of law."
Smith said the case also illustrates how the practice of law can be disconnected from reality. Part of the arguments presented to the Supreme Court centered on a few arcane precedents that involved whether the health care act is part of Congress' commerce power or its taxing power.
"This whole legal argument is form over substance," Smith said. "It's only because Congress was politically cowardly and did not want to use the T word – tax – that we're in this whole three days of legal discussion."
If the Supreme Court overturns the legislation, the change could be disruptive, because some reforms have already been put in place, Yphantides said.
The program, "Life, Liberty and the Pursuit of Healthiness," was the first program for the newly formed UCSD Alumni Legal Professionals Network.