Rx For Reform: The Health Care Balancing Act

Let me finally get down to some of the issues involved in health care.  This piece will not be a treatise on the nuts and bolts of the variously proposed facts and figures.  I will leave that to the policy wonks.  Rather, I will, through my experience as a consumer of health care in our country, an insurance policyholder and an employee in a medical office for over 25 years, attempt to give an overview of the changes we need to provide health care worthy of our nation’s ideals.  Keep in mind that my recurring theme has always been a fair, just and ethical government, no matter what specific issue is at hand.  First I will address the process of designing this system, the political and financial mechanics.  Then I will deal with some basic principles that are a “must” for our health care to be effective and relevant.  And finally, I have to mention some of my own pet peeves.

I understand President Obama’s focused aim to get this health care policy from the Congress, rather than from his own office; the mandate would be larger and more meaningful.  The Clinton’s health care initiative came from the White House, and was slammed down from the get-go.  However, our President  must be careful about certain procedures.  First, as soon as Al Franken is seated as the junior senator from Minnesota, there will be a filibuster-proof Democratic majority in the Senate.  I urge him to rely on that majority and not waste time and effort on coaxing the GOP to add their line items.  That would be a fruitless course.  The Republicans simply say “No” to all bipartisan proposals because their only game plan is to destroy the party in power.  Secondly, it will be important for President Obama to stand firm on the specifics of the policy once they are laid out.  If he chooses to dilute the policy and introduce drastic changes in the spirit of bipartisanship, consensus and compromise, he might then lose some of his initial supporters who would correctly view the altered policy as totally different from the one they supported at the beginning.  So I urge our President to listen to all reasonable ideas, work through them while trying to overcome the opposition’s destructive tendencies, and then go with what makes the most sense in terms of coverage and costs.  Content and substance should have a higher priority than speed, although history had shown that a new President will never have as much power as he has in his first year in office.  So President Obama is faced with yet another careful balancing act.  Under no circumstances should the GOP and, I might add, rogue Democrat lawmakers looking out for their own personal electoral popularity and rewards from health care lobbies , be allowed to high-jack a national health care coverage program.

It is high time for the United States to have mandatory, universal health care coverage for all of our citizens.  We are the only industrialized nation in the world which offers no such program.  It is a blight on our reputation as a fair democracy and outright neglect on behalf of our citizens.  We have never had a health care “system”; rather, medical coverage has been a slapped together, change-the-rules-in-the-middle, cover-your-ass hodgepodge of exclusionary, discriminatory, greedy and vengeful non-policies.  The time is now and President Obama must be very firm about his leadership goals.

There are a number of aspects that must be included in any viable, beneficial health plan.  To begin with I am of the mind that supports a public option.  In my more volatile moments, I tend to back a single payer system.  Knowing that that will never happen at this time, I believe that the public option is a necessity for a successful program.  Why, you might ask?  As directly as I can state, there must be the public option in order to keep the private insurers honest.  The private insurers are greedy and  dishonest about paying for one’s designated benefits and ignorant about what health care delivery signifies.  They think that health care delivery is keeping as much money as possible for themselves.  They are not interested in positive health outcomes for their policyholders.  Their overriding concern over and above all else is their bottom line.  These private entities are in no way, shape or form health care insurers; they are simply loss minimizers.


Yes, we do need competition to ensure that medical care gets delivered as promised.  The public option would also help reign in the waste inherent in our current jumble of services rendered.  Our Medicare system is the largest health insurer in the world and overall, it has been quite successful, both in the medical care it provides and cost containment.  There is a term that Medicare uses as the holy grail of their coverage: adjusted average per capita cost (AAPCC rate).  This figure is computed for every county and/or zip code in the nation.  Medicare knows exactly how much health care will cost any citizen at any given age in every county in America.  There are pockets of very successful, cost-effective  health plans throughout our country and then there are other pockets of wasteful yet restrictive plans.

Before we can morph into a single payer program, we need to test the waters.  Why not set up some regional plans, using the AAPCC information, and actually see if such a proposal has legs?  Americans will have to make compromises.  Perhaps higher taxes are in the future picture to help defray the costs of health care.  Rationing will occur to a certain extent.  However, with all the waste in our current model, it will not be as bad or inflammatory as the opposition politicians would like us to believe.  Here is an interesting article on rationing:


Furthermore, the health care “system” that is in place now is like throwing good money after bad.  Reform will be expensive, but hopefully,  more financially streamlined, democratic and beneficial.  We certainly can not continue on the doomed path of wasteful care and overwhelming costs we are on now.  Our consumption of health care must be tempered with, on the part of patients and care givers, a reasonable allowance and realistic expectations.  The takers must also be the givers:


Regarding cost-containment vis-a-vis rationing, hospitals will also have to bite the bullet.  Don’t kid yourself by the designation “non-profit organization”, which many hospitals embrace.  In my county, the non-profit status of our hospital system pays its chief executives well into the seven figure range, similar to the exorbitant wages earned by our health insurance companies.  Of course, if I charged $10 for an aspirin or $20 for a sanitary napkin, I too would be pulling down a one million dollar salary.  So there is going to have to be a careful balancing act on all sides: the patients, the caregivers, the insurance companies and the associated sideline enterprises such as malpractice insurers and drug companies.  We are all in this together and every single one of us must make sacrifices.

Our expectations must be tempered.  For example, regarding liability insurance for physicians, there needs to be a state cap on damages, such as we have here in Virginia.  I am well aware that some medical malpractice is real and murderous.  However, frivolous litigation should not be rewarded by huge, punitive payments based on purely emotional reactions.  Until the cost of liability insurance comes down to reasonable levels (which can happen only if caps are put in place for damages), physicians will be scrambling to cover those costs, sometimes in gluttonous and greedy ways.

Which brings me to my most strongly held pet peeve: the minimization of our physicians by referring to them as “health care providers.”  The title “Doctor” has been conveniently removed from their names, as if by omitting their title not only would their personal value be minimized, but also their professional worth.  Does this invalidation mean that health costs would also diminish?  I think not.  Our physicians spend close to ten years in post college education and spend around $200,000 just for medical school.  Unless a person has enlisted in the military to cover their education, no one, absolutely NO ONE, contributes to their medical education besides themselves and perhaps their parents. So yes, you damn well better call your health care provider by his or her  well-earned title of Doctor.

In the New York Times, David Brooks said it all:


Our search for dignity, morality and everything that should be sacred to us, like children, is embodied in this attempt at providing health care for all Americans.  Can we pull it off effectively and cost-consciously, or will it be yet another victory for the haves and to hell with the have-nots?  As usual, my opinion on health care is couched, like everything else I write, in the hope for a just and moral benevolence for all Americans.  In our quest for universal medical coverage, and as it should be in government, politics and life, we have the best possible man on the job.  President Obama’s temperament, intellect and moral demeanor is just what the doctor ordered.  President Obama needs to rely on himself, his instincts, his character.  I know I do.


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One Response to “Rx For Reform: The Health Care Balancing Act”

  1. Health Forums Says:

    enjoyed reading your health care balancing act blog post. I agree that we do need some type of universal health care.

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