Solving the Healthcare Enigma II
As a progressive and a healthcare professional, I have found one thing to be painfully apparent. As a group, impatient progressives in Congress, in their excitement and eagerness to pass healthcare reform apparently failed to complete their homework on the subject! Knowing full well that the ideal vehicle for national healthcare is, indeed, extension of Medicare, they did literally nothing to clean up the massive and unacceptable waste in the program. For Anthony Weiner and Bernie Sanders to call the program the best and least wasteful health insurance program available seems like a cruel joke at best. All they are saying is that Medicare's bureaucracy does not take out a share of the profits (as much as 40% of gross input) as private insurance companies do. No, instead, that extra 30-40% goes to drug companies, pharmacies, durable goods and oxygen suppliers, medical laboratories, illicit hospital and outpatient costs in "legal," government subsidized graft as well as another sixty billion dollars in "illegal" or criminal graft  .
Being a progressive in favor of a single payer system as the ultimate solution to national healthcare, but finding the way Ms. Pelosi and the progressives in Congress handled healthcare reform sickening and "relatively" incompetent, I suppose, could be viewed as an enigma. Not so! The real healthcare enigma is: how can Democrats and Republicans pass meaningful healthcare reform that does not satisfy the insatiable appetites of their respective lobbies. What would Insurance companies, PhRMA (the drug lobby) and foreign manufacturers think if their Republican benefactors actually provided affordable healthcare to the American worker resulting in a few thousand dollars in savings per car for an American auto manufacturer? And, what would those poor durable goods providers, oxygen companies, and medical labs have to say to their Democratic benefactors? Imagine how difficult it would be for those poor souls to charge actual retail prices, anywhere from one fourth to one tenth of what they currently charge "the most efficient medical insurance program there is?"  
If I sound unbelievably angry, it is because I am. The level of audacity or feigned ignorance exhibited by both parties is absolutely appalling! Why should rational people be reduced to ranting about the unconstitutionality of mandated private insurance? Mandating purchase of clearly horrible, massively overpriced health insurance merely to avoid punishment is as clear a case of racketeering as there is! As I, myself, have tried to tell fellow progressives so many times, mandated health insurance can only be paid through taxes! I am not a lawyer, just a small town family doctor employing elementary logic. Too many of our legislators seem to be arrogant, poorly educated attorneys who are too lazy to do their own homework! Not only do they seem to know too little about the reality of healthcare, they appear to know even less about law! Did they forget to include severability in their "relatively" incompetent healthcare package or did they do it on purpose? It's like watching baseball: did the umpire blow the call on purpose or is he just unbelievably inept?
Meanwhile, the Republican Party and 26 of their morally despicable state attorneys general, instead of attacking mandatory private healthcare as racketeering, claim that because total control of insurance has been quite foolishly ceded to the states, only the states are allowed to extort insurance payments from unwilling victims. How comforting; patriotic Republicans want to restrict the privilege of racketeering only to the states!
Surprisingly, instead of cleaning up our only legitimate single payer system and making it presentable to the American people, progressives want to "trick" Republicans into having to accept the wonderful Medicare program as it is. Let's see. If Medicare wastes between one hundred and one hundred fifty billion dollars per year (between "legal" and "illegal" graft) on some forty three million members, how much would we waste on three hundred thirty five million patients?  Considering that the average population is less sick than the average Medicare patient, let's say that the system would waste only eighty billion dollars per forty million patients. This still means at least six hundred and seventy billion dollars a year in overpayments to those same overpaid companies currently feeding at the government trough. That is almost seven trillion dollars in fraudulent overpayments in the next ten years, even ignoring population growth, isn't it? Cat got your tongue, Mr. Weiner? Mr. Sanders? Ms. Pelosi? How about an answer?
Wait a minute. I have an idea. In fact, I have a brilliant idea! As an intelligent compromise, let's create a public option! This would constitute legitimate competition for the insurance industry and give them a chance to survive, to see if they really can provide affordable, decent healthcare coverage. The only real problem is that if it is set up by all of the same apparently incompetent Congressmen and Senators who haven't been able to clean up Medicare, if it is run by the same apparently incompetent bureaucracy that has been paying two to ten times as much as retail prices to those same hungry scavengers who prey on Medicare, then the fate of a public option cannot be left in the hands of these wretches, can it? Time and time again they have made promises: "Just wait til we take over..." What the heck were they doing for those eight worthless years of Junior Bush's "reign?" While some of us were studying about healthcare, apparently they stood by helpless, letting the child-king play in his government waste and cried "we can do better than you!"
Thank you progressives, but having your hearts in the right place is no substitute for having your heads in the right place! I too am a progressive. I believe that a well thought out single payer system would appeal so strongly to a majority of Americans, that even the Republican Party would not be able to deny it to them. If voters cannot be convinced by legitimate governmental examples, then the idea of socialized medical healthcare needs to be scrapped. This is not a dictatorship. The reconciliation bill passed by both Houses is a fiscally irresponsible potpourri of dissociated ideas, some good, some bad and some nonsensical. Unfortunately it is all we have and even that is in danger thanks to the sloppy work done in Congress. If you have to do it again and you don't have the guts to insult your precious lobbies, do us all a favor: don't do us any more favors!
Allen Finkelstein, D.O. 2/1/11
 In 2010 68 billion dollars was budgeted for Medicare Part D. [See Reference] These drugs could have been purchased for less than 30 billion dollars at the V.A. under their bidding system: This represents an overpayment of approximately 40 billion dollars and should run to at least 50 or 60 billion dollars in 2011. Add the fraudulent "legal" inpatient and outpatient billing condoned by Medicare and there is no limit to what is the "most efficient insurance system" will condone!