This interview is part of KHN's video series "Supreme Uncertainty: What's Next After The Court Rules," which solicits views from public officials and policy experts about the upcoming Supreme Court ruling on the health law and its implications for the future of health care.
Bruce Vladeck, who ran Medicare and Medicaid for four years under President Clinton, forecasts "chaos" in the health care delivery system and increased deaths if the Supreme Court strikes down the health law. Killing the law would "save a fortune" for the government, but at the expense of "gutting Medicaid," says Vladeck, who is now a senior advisor for Nexera, a New York hospital consulting firm.
Here is an edited transcript of the interview:
BRUCE VLADECK: If the whole law goes down, the death rate in the United States will go up beginning in 2014. Because we know that the number of uninsured people will not go down, it will go up, and that growth in the number of uninsured people increases the number of people who die, so it’s pretty straightforward as far as I can tell. We’ll also have enormous chaos in the delivery system, but how that will play out exactly is hard to know.
MARILYN WERBER SERAFINI: There are implications for Medicare as well. If the law is struck down, the insolvency date for Medicare gets closer.
BRUCE VLADECK: Well again, it depends what the court does. If the court basically says everything that happened since March 2010 is invalid, you have a hell of a mess on your hands. But, it’s hard to imagine they would do that. Or, to make things even more confused, they might do that but then leave it to lower courts to figure out what that actually means — so, nobody knows.
MARILYN WERBER SERAFINI: Well what effect would that have on the current debate on entitlement spending as it relates to Medicare?
BRUCE VLADECK: I’m sure partisans on both sides would claim it proves their point. But in terms of practical matters, no one knows what the effect of that would be. We’ve never had a situation like this before, where a court said everything that happened in the last 2 1/2 years in a major federal government program is invalid, and so we have to figure it out all over again.
MARILYN WERBER SERAFINI: Would it put some weight behind Republican arguments that we need to significantly decrease spending?
BRUCE VLADECK: I don’t know how it would do that. We’d save a fortune by gutting Medicaid, so in terms of the overall federal budget it frees up more money.
MARILYN WERBER SERAFINI: The health law, since it’s been passed, has faced some public opinion challenges. If it's upheld, how does the Obama administration deal with that?
BRUCE VLADECK: As best as anyone can tell, the reaction to the health law has been founded in an extraordinary amount of misinformation about what’s actually in it and what it will actually do. And it seems to me there’s no better way of educating the public about what the law will do and what effects it will have than just actually proceeding to implement it. I think when people begin to see exchanges offering a range of subsidized insurance products, when they begin to see some of the other things that are happening and not happening as a result of the legislation, public opinion will catch up.
MARILYN WERBER SERAFINI: So do you think that if the law is upheld, is the administration’s problem essentially solved, because it’s then the law of the land and people will move forward? Is it that simple?
BRUCE VLADECK: Well, I don’t know if it’s solved. I think that we have a very profound challenge as a democratic society in the growing disjunction between what’s actually occurring in the world and what the public seems to believe. I think our challenge, in some ways, is just as severe as public beliefs about global warming and energy policy for example. And I think as a society that’s a profound challenge. But in terms of the administration getting through the next couple of years, I think the only thing you can do is keep your head down and go ahead to put the law into place.