healthcare reform


The Well Being

Health care reform examined around the academy

Vol. 13 No. 1
Fall 2010

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The Well Being
Health care reform examined around the university

Health Care Reform
Key provisions from the Accountable Care Act

The Patient Protection and Affordable Care Act
Opportunity and uncertainty for academic health centers

"Among the most immediate challenges we face . . . is our communication efforts with the American public: we need to keep everyone informed about what the new law does and doesn't do, and how it will work for them."

"I'm a great believer that what medicine does best is to think about multiple causes for complex outcomes. And much of what I"ve heard over the last couple of years both in the medical science, sadly, and also in the political realm is exactly the opposite."

Ahead of the Curve
Challenging conventions with predictive health

Broadening our Lenses
Ethical reflections on health care reform

Thomas Jefferson: No Happiness Without Health

Cost Control and Health Care Reform
Defusing a fiscal time bomb

The Affordable Care Act
Will the bill improve coordination of care in the U.S.?

Health Reform Law and its Impact on Physical Therapists
Value across the spectrum of care

Placing Addiction in Historical Perspective
Health care reform and the limits of abstinence policies

Further Reading



As a health care provider and consumer and as a place of medical research and scholarship, Emory University is uniquely positioned in the public discourse around health care reform in this country. In the national media and debates, informed voices from this institution have offered compelling perspectives on matters ranging from policy and implementation to constitutionality and ethics.

In this issue of the Academic Exchange, we aim to bring Emory’s substantial intellectual resources to bear on the issues surrounding the Patient Protection and Affordable Care Act (PPACA), voted into law on March 25, 2010. From the health sciences and social sciences to the humanities, business, and ethics, Emory scholars weigh in with their expertise on the ongoing conversations about health care reform in the U.S. and its implications for issues such as cost, quality, access, policy, and practice. Their writings deepen and expand our understanding of health and care in this society. For the individual patient and practitioner as well as the full population facing new and challenging epidemics, the notion of “well being” is in flux.

With those shifts in mind, in these pages, Kenneth Thorpe, Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management, provides an overview of the new legislation and what it aims to do, and University Chancellor Michael M.E. Johns and John T. Engelen, Vice President for Governmental Affairs, offer their take on what the PPACA means for major academic health centers like Emory’s. And in a Q&A, Ruth Katz, Emory Board of Trustees member and chief public health counsel for the Committee on Energy and Commerce in the U.S. House of Representatives, offers an intriguing Washington insider’s view of the legislative process.

Then we broaden the lens. In a second Q&A, Sander Gilman, a prominent cultural, medical, and literary historian, questions some of the assumptions behind the reform bill’s economics and approaches to disease prevention. And anthropologist Michelle Lampl, also a leader in Emory’s Predictive Health Institute, presents a view of health care reform grounded in prevention rather than disease. Kathy Kinlaw, who directs the program in health sciences and ethics in Emory’s Center for Ethics, invites readers to consider the concepts of justice and liberty and their place in the national discussion of health care reform. And Andre Nahmias, emeritus professor of pediatrics, offers an insight drawn from the correspondence of Thomas Jefferson, eleven years prior to the penning of the Declaration of Independence, placing “health” among those values key to the pursuit of happiness.

Several of this issue’s contributors then take a look at specific provisions in the reform bill. David Howard, in the Department of Health Policy and Management, looks at some pragmatic and critical issues around health care spending and the bill’s measures in addressing a growing problem. Howard’s departmental colleague, Steven Culler, who also has an adjunct appointment in the Goizueta Business School, examines some new endeavors under the act to better coordinate patient care (and thus reduce inefficiencies) nationwide. Zoher Kapasi, associate professor and interim director of the Division of Physical Therapy, shares his predictions for the impact of the reform bill on his profession and his students, who are preparing for careers in a dramatically changing professional environment. And Deanne Dunbar and Howard Kushner bring their perspective as historians of medicine to addiction treatment over the past several decades in this country and how health policy may once again change prevailing practices.

As always, the Academic Exchange is a place for ongoing conversation. We invite feedback and comment, voices, and perspectives on this topic not heard in this particular issue. Please send your remarks to me at —Allison Adams, Editor