We have moved past the question of whether health reform should have passed; now the focus is on implementing the new law and controlling costs, said speakers at a health policy forum hosted by the School of Medicine on April 1.

Dean Philip Pizzo, MD; Stanford Health Policy Director Alan Garber, MD, PhD; and Alain Enthoven, PhD, emeritus professor in the Graduate School of Business, discussed the elements and efficacy of the health-care reform legislation that President Barack Obama signed into law in late March. The 90-minute exchange, moderated by Daniel Kessler, JD, PhD, a professor of law, of business and of health research and policy, brought an overflow audience to the Clark Center auditorium.

Key features of the law include extending health coverage to 32 million uninsured Americans, preventing insurance companies from denying coverage to those with pre-existing medical conditions and requiring most Americans to buy health insurance. Government officials predict that the law will reduce federal deficits by $143 billion over 10 years.

Enthoven was the most critical of the legislation, saying he would have voted against it. "This bill doesn't even begin to fix problem of cost growth," he said. "It has been said, ‘Oh well, it reduces federal deficit over next 10 years.' It's painful for me to realize that's simply misleading."

Garber and Pizzo also expressed concerns about the cost of the legislation, but both noted that doing nothing would have been worse for the health-care system. "We were on a trajectory that was leading to unsustainable system," Pizzo said. "Imperfect as this (bill) is, my view is this is a start."

Both Pizzo and Garber were generally supportive of the law's insurance coverage expansion and cost-reduction elements. "This was an extraordinary legislative achievement," said Garber, an expert in comparative-effectiveness research. "For many of us, this was the most dramatic step forward in terms of coverage that we've seen in our lifetimes."

Each panelist raised the concern that the bill does not directly tackle the perverse incentives in the health-care system --  for instance, paying doctors for each service rendered (the so-called "fee-for-service" approach), which induces medical providers to prescribe more tests if they desire higher profits. Though  Garber noted that the legislation takes initial steps to address the issue by creating a center for innovation under the Centers for Medicare and Medicaid Services. Such a center will test programs aimed at making care more efficient while improving health outcomes, and may find alternatives to the fee-for-service approach.

Garber and Pizzo frequently returned to the theme that the law is not nearly as comprehensive as either desired, but said that steps such as the innovation center and the creation of an independent advisory board give them hope that a better health-care system is possible.

Kessler, who joined Enthoven in opposing the law, expressed hope that the controversial parts of the legislation - specifically, the deficit implications and the long-run macro-economic consequences - won't be as bad as other opponents say.