Bob McMillan has had an interesting and diverse career. His profession is law but he has served in many high profile executive positions including being a corporate officer at Avon, CEO of the Panama Canal Commission, a board member of Empire Blue Cross, and board member of the American Medical Association.

This morning he took on the task of explaining the national healthcare plan that many people refer to as Obama Care. The discussion was centered on the possible outcomes of the Supreme Court as they test the constitutionality of the legislation.

McMillan pointed out that Teddy Roosevelt promised to enact a healthcare program if he had been re-elected in the early part of the 20^th century. President Nixon proposed a healthcare plan that was more encompassing than this one. Mr. Nixon unfortunately had another bag of alligators he had to attend to, namely Watergate and impeachment. Hillary Clinton guided the Bill Clinton administration efforts toward a healthcare plan. Well that went nowhere as we all remember

Now that a healthcare plan is in place and has been challenged by lower courts, and the results of those challenges are mixed. So here come the Supremes. What will they do?

Bob drew for us a very pessimistic picture of the present cost of Medicare stating that the system would be kaput by 2024. He cited the cost of drugs, the duplication of testing, the cost of creating and maintaining paper files, malpractice insurance costs, end of life heroic measures and the associated costs

All of the negatives in the plan revolve on the items in the above paragraph. All of which can and should be addressed.

He went into some positive points in the legislation, such as; keeping children on the parents policy until age 26, no lifetime caps, insurance exchanges which should bring the cost down but 30 states do not have them.

The possible Supreme Court decisions run the gamut from;

1)      Totally upheld – nothing changes

2)      Individual mandate rejected

3)      Employer mandate rejected

4)      Challenge is premature- this essentially says that no harm has been done to any entity as of yet, and can only be challenged when a party can show harm.

The most interesting points were made by the speaker and by the audience after the formal presentation. The out of control elements cited above already exist. It is the reason US healthcare costs are twice as much as the next most costly system. While that is bad the cost is not justified by better outcomes. There are numerous countries that have better health outcomes.

It was pointed out by the speaker that some states have severely limited malpractice and their malpractice insurance is commensurately less. As much as 70% less.

I asked why the medical profession does not do what industry has done with workers compensation. There was a time when employers could be sued. Workers compensation has removed that sword of Damocles from employers and created an orderly no fault process that compensates every injured worker. In medicine there are outsized awards in some cases and absolutely no compensation in others. Why not create medical compensation boards with the same no-fault mentality guiding the system.

I think most of us came away thinking that this is not real good legislation, but there is nothing here that cannot be fixed if congress wanted it fixed. Let’s see!