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Universal Health Care

The high cost of health care is being debated in California and elsewhere in the U.S. The best suggestion comes from Dr. Arnold Relman.  He was a respected professor and one-time editor of the New England Journal of Medicine. His book “Second Opinion” explains how health care can’t be treated as just another business. Even in the 1970s a noted economist says it doesn’t correspond to economic principles.

However since that time insurance companies have taken over medical decisions. Doctors must spend more time treating their practice like a business instead of being concerned with healing.

He suggests a single payer, the government, to get the lowest administrative costs. Doctors could join together with both specialists and general practitioners in voluntary non-profit groups. Patients could decide which group they wanted and could change if necessary. Doctors would be paid a salary and not by the “piece-work” formula that is driving up costs and not benefiting patients.

You have heard elsewhere that there are 47 million uninsured Americans. Most are the working poor or small business owners who just can’t afford the coverage.

Dr. Relman states that as a country we are spending twice what other advanced countries do per person and are ranked among poorer countries in some criteria like infant death rate.

He says one of the reasons doctors have lost their vocations as healers is because of a Supreme Court decision saying that legal and medical associations could not be exempt from fair trade rules. This has led away from internal regulation of their members and a wide open use of advertising and other business practices. In order to compete, even the most conscientious doctors or non-profit HMOs (Health Maintenance Organizations) have had to consider their practice like a business and cut corners in the name of profits.

Persons who say they don’t want some government bureaucrat standing between them and their doctor seem to forget the many layers of employees in insurance companies or for-profit-HMOs. There are expensive lawyers, statisticians, claims adjusters, middle managers and secretarial staff, all dedicated to increasing profits. Stock holders also expect a profit on their investment and the CEO (Chief Executive Officer) thinks he deserves a salary of several million dollars just like a rock star or professional athlete.

Medicine should once more be a healing profession.

In California Governor Schwartzenegger says everyone should be required to buy health insurance. The government would subsidize the poorer people. To me, this is like saying that everyone should buy bottled water instead of communities providing pure water for everyone. Mandating health insurance would drive up costs even more.

It would be like the boondoggle of the drug benefits of Medicare.  The law was written for the benefit of the drug companies and if not changed will drive up the cost of Medicare and the taxes that support it.

Instead of making insurance companies and pharmaceutical giants even richer, we should change our attitude as suggested by Dr. Relman.  More medical students are women.  (I was only one of five in a class of 70.) Women as well as many men want to be doctors in order to care for their patients not become businessmen.

If you’re in California you may have the chance to vote for Senator Sheila Kuehl’s bill of a single payer plan that some call “Medicare for all ages.”  Like social security it would have a much lower administrative cost than that of for-profit HMOs or insurance companies. If vetoed by the governor, it could be one of the propositions put on the ballot next year.

Of course insurance companies will spend millions to keep their lucrative practices. If the government pays part of their bills for poorer people, they will make even more.

We need health care for all not health insurance for all.