The Wall Street Journal-20080204-The Elusive Prescription for Health Care We Can Afford
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The Elusive Prescription for Health Care We Can Afford
Full Text (823 words)Grace-Marie Turner's op-ed ("The GOP's Prescription for Health Care," Jan. 29) goes over the Republican candidates' proposals for health-care reform. As a practicing physician who ran for Congress in 1994, I notice no one seems to propose what a physician would.
We need to replace our current health insurance system and managed- care disaster with a nonprofit company to transfer payments between patients and doctors. This could be considered a utility company or a co-op. The current insurance companies operate with a profit margin of 14% and other overhead expenses that total 20-40% of total premium dollars spent. No one considers the doctor's expenses of billing and appealing denied claims. This could be one or two employees per doctor. A new system would get rid of the adversarial billing that we currently have and would have the patient owning the policy, not the employer. The employer could still subsidize the costs of valued employees as is currently done. This would make the insurance transportable and obviate pre-existing conditions. We could emphasize prevention.
Malpractice and the fear of lawsuits leads doctors to practice defensively. This cost can only be estimated, but approaches 20-25%. Most defensive medicine consists of expensive technology, such as MRI and CAT scans. These studies are much more costly than an extra office visit. The problem is not only frivolous or junk lawsuits but the entire malpractice tort system. Currently, expert witnesses, who I am sad to say are fellow physicians, have begun a new specialty of "expert witness." These doctors make more money testifying than from the practice of medicine. The temptations are great to lie or stretch the truth. A better system would be mandatory arbitration of all encounters with patients. Other possible new systems are workers' compensation-like health courts where the experts are hired by the court.
Doing both health-care insurance and malpractice reform would save 40-50% of total private sector costs.
Doctors could get paid more and patients and businesses would pay much less. Medicare is cutting doctor fees by 5% for the next nine years. Already many doctors don't take Medicare or Medicaid patients. State Children's Health Insurance Program reimbursement is mostly at Medicaid rates. What would federal-based health care be like?
Also, all of the federal trust funds have zero dollars in them. This was battled over in 2005 in the privatization of Social Security debate. The General Accounting Office Web site shows that every dollar in a trust fund, Medicare, Social Security, federal employee retirement plans, etc., is offset by the liability of the Treasury to pay the bill when due. A socialized system would force the government to ration care to save itself money it doesn't have.
We can save our system which provides the best care in the world and save 40-50%. The question is: Why not do it?
Sidney Goldfarb M.D., F.A.C.S.
Princeton, N.J.
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Grace-Marie Turner's piece on the GOP candidates underscores the lack of clarity on the debate from both sides. Both Democratic and Republican candidates are talking about increases in health insurance, not in health care. The end game for all the policies is Medicare. Medicare is a situation of unfettered demand with the single payer forcing lower and lower reimbursement and higher and higher requirements for documentation. No day passes without notice of health providers refusing or limiting the number of Medicare patients it can accommodate.
The pig of baby boomers will be in the python of Medicare by the end of the next president's second term. Candidates should tell us what they plan to do to increase the supply of nurses, aides, physician assistants, nurse practitioners, family-practice physicians, internists -- all the people in health care.
Agnes Pearson Reading
Ann Arbor, Mich.
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One would like to share Grace-Marie Turner's optimism about what Republicans might do to deregulate health care and put it back in the hands of consumers. Unfortunately, President Bush -- when he had six years of Republican control of Congress -- did nothing except vastly expand the role of government in health care. At the same time Gov. Mitt Romney was doing the same in Massachusetts, and Gov. Arnold Schwarzenegger was trying to do the same thing in California. That does not provide much ground for encouragement even if some candidates are now making some good proposals. Perhaps we should not put our trust in princes, whether Republican or Democrat, but just focus on the right principles -- like personal choice and the rights of individuals to manage their own health-care decisions.
Richard E. Ralston
Executive Director
Americans for Free Choice in Medicine
Newport Beach, Calif.
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Ms. Turner writes that the GOP presidential candidates "believe that bringing millions of new buyers into the health-care [insurance] marketplace will expand competition and force insurers and providers to offer more affordable options." But let me ask this, when demand for a good or service increases, what happens to its price?
Greg Bombassei, M.D.
Avon, Conn.
