A Message To Secretary-Designee Daschle – How to Reform Health Care


Health Care reform needs creative thinking. Policies and procedures of the past just won’t do. We can’t just copy Canadian health care systems. Nor should we just leave everything to the “free” market. Free market theory ASSUMES one is ABLE TO make a choice for the most competitive service provider.

First we should analyze what is the meaning of health care. In America we have fire and police departments, public road maintenance, and other public services  where the employees provide services to the captive public for a salary. How well they do their work or how much work they do is not tied to their salary. When a burglar confronts you with a gun, or there is a fire at your house, there is no ability for the person in this “captive” market to shop around. I believe that Americans think that fire and police protection, garbage collection, etc are a right. 

These are not areas where there are super exorbitant  profits for those that supply the fire engines, police cars, and garbage trucks or who man the fire engines, garbage trucks, etc. Competition for services and supplies is somewhat limited. Therefore, the principles of the free market capitalist system just doesn’t work well.  

The questions is do Americans now believe that health care is a right and not a privilege as I do?  I don’t believe that exotic and futile health care however, is a right. Half our health care dollars (my estimate which may not be completely correct) are spent on futile health care at the end of life or the beginning of life.  We need clear guidelines as to when a  person at public expense will be placed under hospice care and taken out of the ICU and guidelines for other such end of life decisions. We cannot give every possible treatment to stretch out misery and suffering to the very last moment, nor keep brain dead people “alive” on ventilators at public expense instead of using that money to help those that can be saved!

If one believes it is a right then WHY do we allow pharmaceutical companies, high-tech health equipment and supplies manufacterors and suppliers the right to set exorbitant high fees without competition in a captive market? Executives of health insurance companies and HMOs, executives of “not-for-profit” hospitals, physicians who perform more procedures than others (heart surgeons, orthopedic surgeons, opthalmologists, etc.) bill exotic fees and make hugely outrageous incomes in the millions to tens of millions of dollars (in comparison to the President of the United States – $400,000, the average family practitioner or pediatrician $150,000, or the executive of other non-profit agencies) when the patients are a captive market who have only limited abilites to shop around. How can a person shop around when they are being taken to a hospital by ambulance for a heart attack and need bypass surgery?  A captive market is NOT a free market. The Milton Friedman model does NOT work with a captive market where people obtain life-saving and essential services. When only one company makes a PET scanner, how can a hospital shop around for competitive bids?

Pharmaceutical companies spend an estimated 50% of their expenditures on advertising. They convince doctors to prescribe marginally “better” drugs at great cost when the doctors could prescribe cheaper and just as effective medications. Yet we allow Medicaid and prisons medical facilities (who provide a LOT of health care in the US) to limit drugs in a ridiculously strict fashion that amounts to medical neglect. The disparities are astonishing in terms of availability of appropriate drugs and the use of unnecessary drugs.

We have 200 times (my estimate) the number of employees as countries with national health plans in the health care/industrial complex just to push around invoices for medical care and collect money from patients who can’t pay.  Hospitals charge 3 Xs reasonable fees to make up for the lack of payment from those who cannot afford to pay and are brought to their hospitals in dire straights unable to choose a cheaper facility.

Employers are expected to pay for medical care and our economy is driven into the ground by this when companies cannot compete due to this “benefit” package.

Lets be reasonable. We need the following and we need creative ways of obtaining it and a national dialogue about how much medical care is a right and how much profit should be allowed to be taken out by greedy people (executives, a minority of doctors, high tech product suppliers and manufacterers, pharmaceutical company executives and stockholders).

1 – remove health care from ties with employers so when you lose your job you dont’ lose your health insurance and to prevent employers from pushing out employees with chronic health conditions that make the companies insurance too costly,

2 – consider excess gradated taxes on advertising of drugs and high tech products to discourage inappropriate use of new expensive drugs, while increasing grants to pharmaceutical companies and research scientists to develop new drugs,

3 – consider either putting doctors and health care executives on a salary, a partial salary, or imposing a steeply progressive excess income tax (say 50% tax on portions of income over $400,000) or some creative variation of this, coupled with free education for physicians and nurses, which would be similar to free education for firemen – this will produce huge savings – why should the CEO of an HMO going out of business get $40 million in a golden parachute as the company goes under – these dollars should be used for health care and NOT TO ENRICH EXECUTIVES OF PHARMACEUTICAL COMPANIES, HEALTH INSURANCE COMPANIES AND HIGH-TECH MEDICAL EQUIPMENT COMPANIES, AND DOCTORS,

4 – regional health care plans instead of employer based plans, which would have to compete against each other,

5 – subsidies or tax benefits for companies that are very small and employ a lot of low paid workers, for the disabled, and the poor to help them pay any premiums,

6 – reduce paper and standardize electronic medical records so there is inexpensive access to information, so that disasters don’t wipe out records, so that services are not duplicated when results are lost, and so that erros are reduced – this will produce huge cost savings that can be used to fund the system instead of increasing taxes,

7 – a VA like health care system that people can choose instead of the private insurance companies,

8- don’t leave the decisions only to the legislators, the AMA, the powerful, and the elite, let those of us on the front line have a say – by being in every working group and on every board concerning any aspect of health care.

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