Monday, February 14, 2011



The following is an intial draft of my Health Care Reform Project. I plan to hone this and then buy a full page in the NY Times and publish it big and bold. I believe that we are being governed by politicians and not by leaders. I hope to inspire the American people to restore personal responsibility, rationality, science, communication, and relationship to the center of the American health care model. I hope to inspire our leaders to lead us forward.

I invite as much comment and criticism as possible. Remeber: this is DRAFT ONE.

True Health Care Reform

The basic tenets of my proposed health care reform are:

(1) Restoration of personal responsibility
(2) Cessation of managing the mundane
(3) Cessation of catastrophizing the usual
(4) Prevention of adverse outcomes and restoration of damage and restitution of loss
(5) Restoration of pharmaceutical industry professionalism

(1) Restoration of Personal Responsibility

Twenty years ago Americans took great responsibility for their personal finances. When you went to a doctor, you paid the doctor. Simple. No middle-man. No problems. It was affordable to all. Routine doctors' fees were one-half to one-tenth the cost they are today and were not a burden. The family doctor was a part of the family and usually cared for many generations of the family. Relationship was important and was significant in the efficacy and quality of the medical care.

Shortly thereafter, the HMO's invaded and fees skyrocketed. What happened? For the hope of getting something for nothing, the cost of medical care mushroomed. Perhaps worse, the doctor-patient relationship was severed: there was a middleman, a barrier to the interpersonal dynamic.

Fear and greed were the driving factors. Fear of loss of income drove doctors to participate with the HMO's and insurers. Patients were promised that they would get care for free. Insurance companies saw new markets to penetrate and new "products" to sell. The face of medical care was changed not by science or medical art, but by intermediary fiduciary agents with no motivation but profit.

And the uninsured? In the first half of the twentieth century no one had insurance! The impoverished got care. Doctors and hospitals rendered charity care for almost one-third of their patients. They did so preserving the dignity of those in need. With the advent of insurance, the uninsured became medical pariahs unable to afford the escalating costs.

The solution is obvious: we need to empower Americans to resume personal responsibility for their health, health care, and health care dollars. We need to remove the middlemen. We need to radically deflate the costs of healthcare by ceasing to manage the mundane and make catastrophic the routine.

(2) Cessation of Management of the Mundane

What is "insurance"? Insurance is the pooling of financial resources to guard against catastrophic financial loss, born by the population at risk. Traditionally, a modest profit was earned by those who managed the pool,

Insurance companies no longer insure against catastrophe or the unanticipated unusual cost: instead they manage the mundane usual costs of medical care. With management having the opportunity to cut a piece of the pie for themselves, they choose the biggest pie and thus manage everything. It really does not matter what the cost is if they can pass the cost on to their customers. The health insurance industry grew in scale out of all proportion to the rest of the economy, consuming the health care dollar.

Employers more often than not pay the bulk of the insurance costs as an often mandated (by government or contract) benefit for employees. As health care costs rose, they sought the best bargains in order to save money. In order to reduce the cost of premiums, the insurers curtailed benefits, never by reducing profits.

(3) Returning Routine to Affordability

The care for routine care or minor illnesses has taken on the financial appearance of a health catastrophe. Emergency rooms render primary care at ten-fold the cost. Resources designed for truly emergency situations are now swamped with routine care. Costs appropriate for true emergencies are now applied to trivial illnesses. The medically indigent are forced to use emergency care services, utilizing resources without financial responsibility.

Regulations have forced simple procedures out of the office and into the hospital or outside lab. A urine culture can be competently performed in a doctor's office for under $10, but is now sent to the lab for over $100.

(4) Preventing Problems and Repairing Damage

Malpractice reform does not belong in the courts. It belongs in the hands of the medical professionals and their patients. Relationship, communication, and personal responsibility are at the center for the reduction in the malpractice problems. Physicians must practice better medicine and relate more thoroughly with their patients. They cannot be too busy nor have any motivation other than rendering the best care possible. Decisions must be made by the patient and must be well informed. Patients must own their decisions and own the risks. Adverse outcomes must be evaluated. If errors are made they must be owned. If damage is done, it must be handled. If responsibility for damage can be ascribed, then it must be done fairly.

(5) Pharmaceutical Industry Professionalism

The pharmaceutical industry has abandoned its heart, soul, and conscience and even its science in pursuit of profit. There is no doubt that there have been remarkable new pharmaceutical inventions and discoveries, but ninety-nine out of each hundred new drugs is either a trivial improvement or a clever repackaging of an older medication. Markets for prescription drugs are deceptively created and exploited by direct to lay advertising. Research is done in secrecy and guarded by federal rules to preserve patent rights, eliminating the possibility of scientific debate and oversight. Physician education is cleverly skewed by industry representatives.

To restore professionalism we need to eliminate direct-lay advertising and non-informational professional advertising. We need to re-open the channels between academia and pharmaceutical industry research. We need to demand real science with head-to-head comparisons of similar drugs, and clear risk-benefit analyses.

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