Most people agree that the United States health care delivery system needs to be changed. That is where the agreement stops. There is much confusion over what form it should take. There are many people who are just afraid of change and therefore want nothing to happen. There are many people who are at the far left hand side of the political spectrum and would like healthcare to evolve into a taxpayer funded socialized system. There are people on the far right side of the political spectrum that want it to stay a generally privatized system, with private health plans funding the healthcare of the profitable patients. Neither of these would work for the United States.
The people who are against healthcare reform always bring up the specter of "socialized medicine" and of the problems with healthcare delivery in other countries. They denounce reform of any kind as leading to one of these situations. People on the political left use many scare tactics in encouraging healthcare reform and want to put in its place a system that guarantees health care to everyone, regardless of cost, regardless of the national debt, and devoid of personal responsibility. I want reform because we need reform! I do not want the United States health care system to be unduly influenced by either of the above political mindsets. If any one of us was charged with setting up a healthcare system from scratch, we certainly would not use the system that we have in place and I doubt we would use either of the above extremes. We need a fresh look.
Opponents of reform are most interested in preserving private insurance health plans. There is so much money generated for private enterprise in healthcare delivery that I can understand them not wanting to give up their "cash cow." I would challenge anyone to explain adequately why the private insurance plans are even beneficial. I deal with delivering health care to several thousand individuals a year. I work with all payers including private health plans, Medicare, Medicaid, TennCare, and persons with no insurance at all. When comparing the healthcare that is given to a patient with the very best private health insurance available to a patient having Medicare with the supplement, one realizes that there is no difference in the care they receive. Each patient gets the same tests, can be placed in the hospital as needed, has drug formulary coverage, and gets out-patient follow-up. The only real differences that I see are that the patient covered by private insurance requires much more pre-certification paperwork and that the private plan is much more expensive to have in place, to start with. The financial difference is the cost of buying the private plan, the expense of the mountains of paperwork, the burden of the health plan administration, and the guaranteeing of their corporate profit margin. To my knowledge, private health insurance only takes from the system and gives nothing in return.
The very thought of changing anything as important as healthcare scares many people. Why is it that Medicare is desirable for a person who is 65 years or older, but is undesirable for a person 64 years of age, or younger. Why is age 65 so magical? I challenge any insurance plan CEO to justify their existence to me, and to the public. A debate in public would be fine, if a suitable forum and sponsor can be found. At least we could have a running exchange in the media.
We need healthcare reform. We need to rid healthcare of the burden of the giant profit machines. We need universal coverage. We need a single party payer. We need to encourage and to mandate a level of personal responsibility. We need our healthcare system administered by private citizens through an autonomous institution setup by Congress, but independent of Congress, such as with the Federal Reserve Board. Our government cannot be charged with administering healthcare, only with helping to collect the money to fund it. It cannot be funded by the tax-payer.
I welcome all comments and criticisms.
Mark E. Green MD
463 POB BMH
Maryville, Tennessee 37804