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Paul Keckley, executive director of the Deloitte Center for HealthSolutions, says that many of the deals that were made to get thisbill passed depended on the existence of the mandate. If themandate is rejected, he expects that many entities such as medicaldevice companies, pharmaceutical companies, insurance companies,and hospitals will appeal the concessions that they made, which heestimates to be worth about $155 billion. "They will want a redo," he says. "Without the expected revenuecoming in to the system, they will need it." Notably, he says, physicians did not make concessions, and ifthings start to unravel, he predicts they will not find muchsympathy on Capitol Hill. "It is hard for Congress to feel too sorry for doctors right now,as Joe Six Pack's disposable income is going down," Keckley says. Primary care is going to find itself "in a holy war to say we arecentral to a rationally delivered system and we demand a place,"especially as compared with specialty care (see "Preparing for thefuture, regardless of reform," page 25). Keckley says he alsothinks that it is likely that in this scenario, Congress may letthe matter default to the states, because they are not bound by theCommerce Clause. "This is a popular concept among a lot of governors, who want tokeep the decisions closer to home," he says. "However, you shouldexpect the states to ask the federal government for more money inthis scenario." Wax, however, disagrees that overturning the mandate would be a baddecision, saying it would be a victory for freedom of choice andthe free market. It would be good for PCPs, he believes, because itcould open the door to applying free market reform to healthcare,such as allowing insurers to compete across state lines. IF THE ENTIRE LAW IS RULED UNCONSTITUTIONAL Tossing out the entire bill will put the U.S. healthcare systemback to "square one," Albers says. Many people will stay uninsured,and specialty care will continue to be emphasized over primarycare. "If this happens, physicians will begin to unwind thepreparations they have made," he says, such as considering addinganother physician, increasing office space to accommodate morepatients, or exploring an ACO. "Primary care had a huge reason to celebrate the passage of thislaw and some trepidation about it being overturned is reasonable,"Albers says. Many insurers have started their own projects to recreate the ACOconcept, and Albers says it will be interesting to see whether theycontinue to move forward with these plans if the law is rejected. The AAFP's Stream says that Congress' response is the wildcard inpredicting what will happen if the court strikes down the entirelaw. Will it reinstate some of the more popular principles, such asallowing adult children to remain on their parents' coverage untilage 26? How will the upcoming election affect those decisions? "It's hard to know what they would do," he says. Shell agrees that this scenario puts the country back to "squareone" but says this can be a positive occurrence if it allows otheroptions to emerge. Gross says: "It is the only way for us to save the practice ofmedicine. We would be going backward, but it's backing away from acliff." NO DIFFERENCE EITHER WAY? Although some experts see the upcoming Supreme Court decision as amonumental one, some disagree. David U. Himmelstein, MD, FACP, an internist who is a professor inthe City University of New York School of Public Health at HunterCollege, visiting professor of medicine at Harvard Medical School,and a co-founder of Physicians for a National Health Program, doesnot believe that PCPs will see much difference from the ruling. We are high quality suppliers, our products such as China Portable Patient Monitor , Digital EEG Manufacturer for oversee buyer. To know more, please visits Stainless Steel Surgical Instruments.
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