Court ruling on Affordable Care Act: Some urologists cower, others rejoice

Practicing urologists share these concerns, but some are also staunchly in favor of the provision of health care for all Americans. Urology Times talked to urologists around the country about their reaction to the decision, what they would like to see changed, and what, if anything, they liked about the law.

All of the physicians were taken aback at the ruling, some less so than others, and their responses varied widely at what the law might mean for their practices and the delivery of health care in this country.

"We are a nation of laws, but I'm afraid for the future of health care in this country because the way they constructed that law, within a couple years we'll have government, single-payer health insurance. The problem is that anywhere in the world that has government single-payer health insurance, they tell you how much they're going to pay-not how much the need is, but what they can afford.

"We have a great health care system and we'll certainly see a deterioration in innovation. [Practicing medicine] will be a job, not a calling, so the impulse will be not to care for people who are seriously ill."

Nothing more than a tax

"I didn't think it would all be overturned, but I was surprised the decision came down the way it did. I was surprised that, essentially, five justices supported it as legal," he said.

Dr. Loughlin, professor of urology at Harvard and senior surgeon at Brigham and Women's Hospital, says that even though Chief Justice John Roberts sided with the majority, he made an observation about the individual mandate that shouldn't be ignored.

"The chief justice said something very important-that this is nothing more than a tax. You can frame it anyway you like, but the chief justice hit the nail on the head that this is a tax. To say anything else is disingenuous. People need to realize that this tax will directly affect individuals, but will also have a major effect on the states and on the country," Dr. Loughlin said.

"No matter how you feel, philosophically, about the government becoming more involved in people's day-to-day decisions, one thing is clear. If you're going to cover more people and try to control costs at the same time, the arithmetic says you can only do that in two ways. You either have to raise taxes on some people or cut benefits to others who are currently insured."

In practice for 30 years, David Emmott, MD, in Shawnee Mission, KS, was surprised the court didn't "dig a little deeper" when determining whether it was up to the federal government to mandate the states provide benefits for people who would not have previously been eligible for those benefits.

"From my perspective, the federal government was giving themselves the authority to put more burden on the states," Dr. Emmott said.