By Diane Carman

Ezekiel “Zeke” Emanuel told an audience Thursday morning that the United States will be “guaranteed a much better health care system by 2020 because of the Affordable Care Act,” while his debate opponent Linda Gorman countered that the objective of Emanuel and other architects of “Obamacare” was really “to limit our freedom.”

The debate, sponsored by the University of Denver and the Denver Post, revealed yet again how far apart Americans remain on the issue of health care reform two years after its passage.

Emanuel, a University of Pennsylvania professor who served as special advisor to the Office of Management and Budget in the White House during the development of the Affordable Care Act, said that the Obama Administration spent nine months in futile negotiations with Republican lawmakers trying to develop a bipartisan package.

Ezekiel “Zeke” Emanuel

“There was a lot of talk and no action,” he said.

Even when the administration included all of Sen. Olympia Snowe’s demands in the proposed legislation, he said, she still voted against it.

“What’s the Republican alternative?”

Gorman, an economist at the free-market think tank, the Independence Institute, called for less regulation, less government involvement in health care and more freedom for individuals to pay for their own health care without interference from insurance companies.

“Insurance is the most expensive way to pay for health care,” Gorman said. “Let people decide what care they need.”

Emanuel said the Affordable Care Act is designed to address three problems with health care in the U.S.: lack of access to the 50 million people who are uninsured, uneven quality across the system and runaway costs.

“In 2012, the United States will spend $2.8 trillion on health care,” said Emanuel. “Health care spending here is the fifth-largest economy in the world.”

Gorman called the act’s goals “shiny objects” that look nice but don’t work and actually create serious problems.

“The only way the government knows how to cut costs is to ration care or cut payments to providers for care,” said Gorman, who claimed that the Affordable Care Act would “bankrupt one in seven hospitals and nursing homes.”

Gorman cited the decline in the cost of laser eye surgery over recent years as an example of the free market working to control costs for a service not covered by Medicare or Medicaid and, therefore, not affected by government regulation.

Emanuel said the act will control costs by “changing the incentives.” The longstanding fee-for-service compensation system for health care providers encourages them to wait for patients to get sick and then order expensive tests and procedures, he said. The Affordable Care Act provides incentives for them to keep people well, manage their health care more efficiently and deal with conditions before they require complicated, invasive and expensive treatment.

“We don’t know how much health care anybody needs,” countered Gorman, “And we don’t know how to keep people healthy. Things like cancer, arthritis leading to joint replacement … just happen. We don’t know why.”

Gorman called for a system that provides safety net care for the indigent and lets the rest of the people decide what care they need on their own.

“That’s exactly what the (health insurance) exchange does,” said Emanuel. “The purpose of the exchange is to provide people who don’t have insurance and want to get it on the individual market four options, four levels of coverage that are affordable and subsidized for people who can’t afford it. That’s exactly what Linda is calling for.”

Not so, said Gorman.

“It’s much less expensive to let insurance companies price risk and then subsidize people who can’t afford it,” she said.

Emanuel said the Affordable Care Act will eliminate the cost-shifting that occurs when hospitals and other health care providers charge patients with health insurance for the unpaid bills of those who are uninsured and need treatment.

Gorman said the cost-shifting still will occur, except that under the Affordable Care Act the burden will fall on the taxpayers.

As for the health insurance mandate included in the act, Emanuel said he knows “a lot of people are upset by it. But most Americans don’t want insurance companies to deny insurance to people with pre-existing conditions. There’s no way economically we can require them to cover people with pre-existing conditions without the mandate.”

When asked about the relatively small penalty imposed on those who defy the mandate, Emanuel said the objective was to create a “social norm” around taking personal responsibility for insurance coverage rather than creating an onerous penalty.

Gorman called for the repeal of the Affordable Care Act and that the country “regularize the laws of economics” to let the free market – not the government – be the primary influence on cost, quality and access to health care.

The debate continues and it should continue,” said former Gov. Dick Lamm, co-director of the DU Institute for Public Policy Studies and a moderator of the panel. “These are passionate advocates for their viewpoints.”

The debate is part of a series of events http://debate2012.du.edu/ leading to the Presidential Debate to be held at DU on Oct. 3.