The ethics, economics and legalities of healthcare reform are plaguing the nation’s best medical, legal and political minds as the debate continues in Washington. And if they can’t sort it out, how is the average healthcare consumer supposed to make sense of the issues?

Three UC Irvine experts have agreed to address some basic questions. They are:

  • Dr. John Heydt, president and CEO of University Physicians & Surgeons, senior associate dean of clinical affairs at UCI’s School of Medicine, and family medicine professor;
  • Dr. Alberto Manetta, director of diversity & community engagement at the School of Medicine and founding director of UCI’s Program in Medical Education for the Latino Community; and
  • Paul Jesilow, professor of criminology, law & society known for his research on healthcare fraud and co-author of “Prescription for Profit: How Doctors Defraud Medicaid.”

Each supports the reform goal of providing healthcare to all U.S. citizens while cutting costs. Here are their thoughts on how to get there.

Q. How can we afford healthcare reform? 
Jesilow: President Obama and others have pointed to eliminating waste as a politically acceptable means. We could pay all healthcare costs for the uninsured by eradicating fraud and abuse in the healthcare industry, which accounts for up to 10 percent — or $200 billion — of total yearly spending. It’s very difficult to prove criminal intent in these cases; simple mistakes or accidents are often blamed. Some of this behavior is very blatant, from doctors who bill for patients they never treated to doctors who bill for unnecessary treatments.
Manetta: There are no plans being considered that could lower costs significantly, especially in the near term. One of the largest expenses — prescription medication — will remain market-driven and uncompetitive.

Q. What is the “public option,” and is it a viable way to contain costs? 
Heydt: The public option is the federal government creating a taxpayer-funded health insurance plan to compete against the private insurance plans. Currently, 70 percent of insured Americans are covered by a private plan. It is not known if the public plan would control costs, which is different from controlling payments. It’s more likely that a public option would eventually put the private plans out of business, and U.S. healthcare would morph into a single-payer system run by the government.

Q. Sweden has a single-payer government system. How does it work?

Jesilow: The Swedish system is not perfect, and many Americans would object to it. But it works for Swedes because it reflects a national sense of solidarity. Everyone is covered — native Swedes and legal immigrants. Local governments pay for healthcare and own and run most hospitals, supported by a 25 percent sales tax. Doctors practice medicine in a no-fault system and are not sued for malpractice. Sweden spends about 9 percent of its gross domestic product on healthcare. In the U.S., it is closer to 16 percent.

Q. Why are so many people against the public option? Is it more than just economics? 
Manetta: Yes, there are ideological reasons. Much of the criticism can be seen as just a political game being played with the health of U.S. citizens. The public option was one of the first wishes of the Obama administration in relation to healthcare reform. There are some who believe that without a public option, there is no true reform.

Q. Are there advantages to maintaining the status quo? 
Heydt: Some elements of the current system are extraordinary. Unfortunately, we have not created a consistent system of care. A high percentage of Americans with health coverage are satisfied with what they have. As we pursue reform, we want to preserve and perhaps improve healthcare available for this population as we manage the problems associated with the 40-50 million Americans with no health coverage. We also want to preserve and improve upon incentives for a strong medical education system and support robust medical research. This will ensure high-quality healthcare for future generations.

Q. Why is healthcare reform such a divisive issue?
Jesilow: The division is likely the result of news media portrayals intent on generating material for the 24-hour news cycle. The nearsightedness of opponents to any healthcare reform is very disturbing. The future of the U.S. depends on getting the system under control and lowering costs. Rising healthcare expenses will make it very difficult for companies to compete in the global economy.
Manetta: It’s divisive because there’s so much money involved. Money can buy lots of people, subsidize political campaigns and acquire media time. Also, the perception exists that the opposition will oppose reform efforts regardless of the merit of the issue being considered.

Q. What will become of Medicare and Medicaid? 

Heydt: Short of a government single-payer option, both would need to continue. Medicaid is a significantly underfunded program that encourages hospitals and physicians to cost-shift to private insurance plans. Medicaid and Medicare will likely always be targets of decreased funding and reimbursement for doctors and hospitals.

Q. How do you see reform affecting hospital services and access to primary care? 
Heydt: If reform is appropriately designed, hospitals will be able to continue to offer the services needed by the patients they serve. And healthcare reform would probably increase the number of primary-care physicians.
Manetta: None of the core issues will be resolved. Most of the universal coverage plans being considered have exclusions and exceptions. And undocumented immigrants will not be allowed to buy insurance, so they’ll continue to receive healthcare in emergency rooms at a significant cost to everyone.

Want to learn more?
UCI’s School of Social Sciences will present “Healthcare Forum: Making Sense of the Healthcare Debate” at 7:30 p.m. Tuesday, Oct. 27, in Social Science Plaza A, Room 2112. Panelists will be:

  • Felicia G. Cohn, director of medical ethics at UCI’s School of Medicine;
  • Joseph Dunn, former CEO of the California Medical Association and former California state senator;
  • Dr. C. Ronald Koons, clinical professor in UCI’s Department of Medicine;
  • Leslie Lindgren, staff attorney at Orange County’s Public Law Center;
  • Dr. Don McCanne, senior health policy fellow at Physicians for a National Health Program; and
  • JB Fenix, California Physicians Alliance fellow and student in UCI’s Program in Medical Education for the Latino Community.

About the University of California, Irvine: Founded in 1965, UCI is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UCI is among the fastest-growing University of California campuses, with more than 27,000 undergraduate and graduate students, 1,100 faculty and 9,200 staff. The top employer in dynamic Orange County, UCI contributes an annual economic impact of $4.2 billion. For more UCI news, visit

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