Wednesday, June 24, 2009

The Biggest Key To Health Care Reform In The U.S. Is YOU!

I want you to look at the following list and then tell me what the title should be. Ready...

1) Heart Disease
2) Cancer
3) Stroke
4) Chronic Lower Respiratory Diseases
5) Accidents
6) Diabetes
7) Alzheimer's Disease
8) Influenza & Pneumonia
9) Kidney Disease
10) Septicemia

Do you have a guess as to what this list stands for yet? Need some help? This is the final report of the leading causes of death in the U.S. for the year 2006 which was published in April of 2009 by the CDC.

According to the National Coalition On Health Care the U.S. spent a total of $2.4 trillion dollars on health care in 2007 which works out to be $7,900 per person and 17% of our total GDP. If nothing is done with our current system then these numbers are expected to reach a total of $4.3 trillion dollars by 2017 which would be equivalent to 20% of GDP. All of this while we currently have a little over 15% of the population with no health care coverage and many more millions under insured.


But you already knew that now didn't you. So what can we do about all this? We could argue back and forth like the politicians do. They quickly forget about people like my friend Kate - Health Care Reform Touches Home.

However, I truly believe that there is a better answer. I believe that an overwhelming majority of our health care expenditures come down to the many decisions that YOU and I make on an everyday basis. That's right! Our success or failure as a country to reduce costs in an effort to provide access to quality health care for all Americans is not determined by our government or politicians or even our doctors. It's determined by YOU and I! How is this you say?

In Part I below I will explain to you how the everyday choices of over 300,000,000 Americans has a tremendous impact on 7 of the top 10 leading causes of death from above excluding accidents, influenza & pneumonia, and septicemia. Your choices in diet, exercise habits, and lifestyle are the major determining factors of not only your own overall health care costs in these regards but also everybody else's too. And it is in these key areas where the majority of success can be obtained in providing long term health care reform in the U.S.

In Part II below I will discuss some key points that I believe need to be taken to correct the inadequacies of the structural and organizational components of our current health care system. And I would encourage you to write your federal representatives as I have done so already to voice your opinion and provide them with your solutions regarding health care reform. Here is a website for you to find their information - Contact Your Representative.

Part I

If everyone including you chooses to take a more responsible role in their own individual lives then we as a country can virtually eliminate 7 of the top 10 causes of death in the U.S. and substantially reduce overall health care costs. Here's how you and I can do this...

  1. Diet - The vast majority of Americans have an extremely unhealthy diet. This is by far the most important area in my mind where we can make a difference. As Americans we eat foods that are much to high in fat, cholesterol, sodium, and many other unhealthy ingredients. This leads to heart disease, strokes, cancer, diabetes, and many more diseases that diminish our quality of life, empty our bank accounts, and ultimately lead to our cause of death. Here's how you can make some major improvements in your life with diet... Transition to a diet that includes only fruits, vegetables, whole grains, plant based proteins, and is low in fat. Remember to also add a vitamin B12 supplement in addition to this. To learn more I highly recommend that you read The China Study by Dr. T. Colin Campbell. You can also view these websites Dr. Caldwell Esselstyn's site, Dr. John McDougall's site, Dr. Joel Fuhrman's site, Vegetarian Times and Shattering The Meat Myth.
  2. Exercise - At least 30 minutes of cardio 3 times a week is sufficient. Don't overdo it! Work at a pace that's comfortable for you. Of course you should always check with your physician to ensure you are healthy enough to start an exercise program.
  3. Lifestyle Choices - Stop smoking and/or drinking excessively! And obviously illegal drugs are out of the question along with inappropriate use of prescription medications. Drinking one serving of red wine a day has been shown to be very heart healthy according to the Mayo Clinic. Find ways to reduce stress which include yoga, meditation, praying, etc. Get plenty of regular sleep - at least 8 hours a day.

Part II

Here are some specific reforms that need to be put in place in order to have a health care system in the U.S. that empowers us to succeed instead of encouraging us to fail as is the case with our current system.

  1. Restructure the reimbursement system to reward health care providers and organizations for providing proactive medical care instead of reactive medical care. Preventative care needs to be the cornerstone of our health care reimbursement system.
  2. Create an alternative public plan that anyone can buy into in order to provide competition to the unregulated capitalistic private health care insurance industry.
  3. Prohibit any public or private plan from discriminating against pre-existing conditions.
  4. Prohibit any public or private plan from making a profit on BASIC medical care. This is done all over the world and done very successfully. Making a profit as an insurance company on lifestyle procedures (face lifts, liposuction, etc.) would be permitted.
  5. Prohibit any public or private plan from setting any annual or lifetime cap on medical benefits.
  6. Allow patients to choose any doctor, hospital, or clinic they want.
  7. Provide the necessary funding for 100% conversion to electronic medical records.
  8. Reduce administrative costs by coming up with one single way that health care providers and insurance companies bill for services. Taiwan currently issues electronic cards (similar to a credit card) to all its citizens and this is what is used for all billing transactions. Their administrative costs are a little over 2% as opposed to over 20% in the U.S.
  9. Invest heavily in diet and lifestyle public education. We've done this before with the stop smoking campaigns over the years and it can be done again with healthy diet and lifestyle education.
  10. Consider subsidizing memberships for U.S. citizens to a gym or recreational facility.
  11. Prohibit lobbying of any kind by any health care related industry in politics. The business done on K street needs to end for good!
  12. Put a cap on the amount that can be awarded for malpractice lawsuits. Individuals and families should be compensated for gross negligence but receiving $10 or $20 million dollars instead of $1 million is not going to make that patient or family happier in the long run. And it only serves to increase costs for everyone due to pure GREED!
To learn more about the pros and cons of healthcare systems around the world watch this program - Sick Around The World. We can learn a lot from our worldly neighbors. We can also learn a lot from practicing preventative medicine. Please visit this website to learn more about that topic - Functional Medicine. To learn more about how the current unregulated capitalistic private insurers work in the U.S. watch this interview with a former Cigna executive - Wendell Potter interview.

In conclusion please realize that we are capable of so much more here in America and yet we settle for less. We have a healthcare system that needs some major reform but ultimately long term success is not dependent on any government program or private insurance company but rather OURSELVES. You and I need to make better everyday choices to reduce not only our own individual costs but the entire nation's cost in general. By making better decisions on our diet and lifestyle we'll also attain the added benefit of feeling better and living a longer life filled with years of positive activity instead of dreadful suffering. And if you're telling yourself that it's just too hard to break old habits then my advice is that any small, positive step forward is better than doing nothing at all.

Thank you for reading this post and feel free to email me at with any questions or concerns and I'll be happy to respond. Please share this with everybody you know to allow for an open and healthy discussion of real solutions to our many health care challenges.


Anonymous said...

I think this is a great piece...aren't your proposals pretty much what Obama has initially proposed?

taochiapet said...

why are "illegal drugs obviously out of the question"?

physicans prescribing medical marijuana now have over 20 years of experience demonstrating it's effectiveness over conventional medications for a whole variety of symptoms. patients routinely discontinue all of their prescribed medications.

it seems that if you're asking for personally responsibility vis-a-vis health and health care decisions, one flip-side needs to be a backing away from our long-standing "control-freak" governing mentality.

Anonymous said...

It's important to distinguish between awards for pain and suffering and awards for economic loss that include future lost wages and future medical expenses. Punitive damages aside, the main reason medical malpractice awards can be so high is that in the case of a person who is left brain damaged or paralyzed, for example, the future medical expenses are astronomical. Lowering healthcare costs would de facto lower verdicts.

Anonymous said...

Any plan that leaves employers in the picture is a non-starter. Health care and employment have nothing to do with each other in a civilized society. So say the rest of the world, but us.

Richard said...

Thanks for your thoughtful piece.

For brevity's sake, I address only two issues.

(1) What are the differences between the various "private" plans and the "public" plan to be?

I can understand that "private" plans might offer basic coverage for $x and additional coverage for $x+. Are all basic plans to cost the same and offer the same coverage, whether they are "private" or "public"? That seems to me to be the only way to level the field between "private" and "public" plans.

If all plans are to offer basic coverage at $x, what is a "public" plan other than a means to provide money to those who are unable to afford basic "private" plans?

Is it under consideration to fold the mechanism for providing those monies into an already existing program, say, Medicare? Or is the idea to set up yet another federal bureaucracy?

(2) If one of the goals of health care reform is to insure good relations between you & me as "patients" and our physicians, why not let physicians provide care, including medications, that they believe will be effective, whether those medications are now legal or not. While we're reforming health care, let's go the second mile and investigate whether our attitudes toward and laws pertaining to currently illegal substances are based on the best scientific evidence obtainable (leaving aside the fact that all science is based on a certain amount of bias) or on age-old, puritanical, or some other prejudice. If the evidence supports the medical benefits (yes, we all know there are going to be side effects: just read the inserts that come with the meds you're currently taking) of certain currently illegal substances, let's legalize them even if that puts some law enforcement people out of work.

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elfish said...

While I agree that many health care expenses are due life-style decisions, there are other bigger causes that are seldom explored. First, the cost of education is so high the every doctor comes out of medical school with huge debts. That means every doctor has to choose an expensive specialty in order to make enough moey to pay back college loans. Second, having worked in health care, I know that doctors demand that every hospital has the latest and most expensive equipment, even if the same equipment is available a block away. Expensive equipment must be used to pay for itself, so lots of extra test are run to pay the costs.

In summary, it is not all the patient's fault. Many of the cost are directly associated with failures in the medical and hospital system.

Palm Harbor said...

I think my situation perfectly illustrates the problem with the American health care system. I am 62 yrs old, have worked my entire life, have had insurance all along. In April 08 I had quadruple bypass surgery. I was sent the bill asking me to remind my insurance co. to pay the bill.... it was for $247,000!!! They paid an amount satisfactory to the hospital. I was told they'd be lucky to get half that amount but if I had to pay, they would demand the whole amount. Now, a year later, my job got outsourced to India for 1/5th of what they were paying COBRA lasts 18 months I believe... then what? If I had Bill Gates's money I couldn't buy private coverage and I'm too young for MEDICARE.

I just have one question for all those opposed to universal health care for all..... if its so bad, why hasn't any country that has it changed back to FOR PROFIT healthcare?

herm said...

Healthcare insurance was started years ago by the Doctors, AMA, and Hospitals.

Here is one of the reasons why healthcare is so expensive:

When John J. Gilligan of Ohio was running for Governor in 1970 and during a TV interview, his father was asked why healthcare was getting so expensive? His comment was, I am on the board of BLUE CROSS & BLUD SHIELD and after what I am about to say, tomorrow morning I might not be on the board of directors or at least I won’t get nominated again when my term ends.

Gilligan’s father said the AMA, the doctors and the medical profession want to get paid in $money$ instead of a barter system or have to wait to collect money due. He went on to say, years ago the medical profession wanted to get healthcare so expensive that people would all have to have health insurance. They lobbied our congress and senate and eventually got their way. They talked (lobbied) health insurance to corporation CEO’s and through TAX BREAKS, finally got corporations to give healthcare to salary workers and then eventually to the common laborer. Now we are all paying dearly for this.

He went on to say, I feel we are simply a COLLECTION AGENCY for the doctors and hospitals. Looking at his last statement, I feel the insurance industry is simply a middleman absorbing a huge amount of healthcare dollars. I don’t know how to find that interview, but it would be very enlightening to read and then see how things have progressed to the present day.

Now…. Who do you think shoved INSURED HEALTHCARE down our throats?

Anonymous said...

A well thought out argument, with only a few minor changes I could name as a retired Physical Therapist.
Proactive care should definitely be added to current reimbursement protocols, with education, but not as the cornerstone of reimbursement, since very few people consult a physician before they are sick or injured.
Though the primary causes of death and illness are a nice guideline, you are assuming that they can be prevented by basic lifestyle changes, many of which are quite subjective, and who is deciding what those changes need to be.
That is where many people are having trouble with health care reform to start with. Do we rely on our legislators to decide what is acceptable and what is not, especially when they have little or no experience in health care and are rushing to pass legislation just because they have to run for election next year.
I would personally feel more comfortable with reform if our legislators, from both houses and all parties were required to live by the standards they are trying to impose on the rest of us.
However, I have been around long enough to know that will never happen.
Thank you for your effort to raise awareness above the fray.

Richard said...

I agree with the anonymous poster who advocates proactive care. I also don't want an uninformed and under-educated congress making health care policy. They appear not to have studied thoroughly the health care system of any other country, especially those of Denmark, Germany, and Japan. And, of course, none of our representatives have stated whether or not they have a conflict of interest because of having taken contributions from pharmaceutical manufacturers, insurance companies, or others somehow or other engaged in the health care business.

As the nationwide discussion of health care reform progresses, I wish we were hearing more of what is in HR 3200 (and less of the promise that we can keep our current health care insurance carrier if we want to).

I am also concerned that many Democrats and many liberal TV talk show hosts, "strategists," et al. assert that the numbers of people who are turning out to discuss with (if not harrass) their representatives are part of a well-organized campaign. Some of these hosts, strategists, et al. have read from what they allege is a memo sent out by some Republican-affiliated group that tells those attending town meetings how to disrupt those meetings. Some of this may be true, but shouldn't the point be what's in the bill, what the representatives are telling their constituents, and what those constituents, when they're being civil, are telling their representatives?

The Republicans, to my knowledge, have not talked much about the bill's content either.

People are upset and angry in part because they cannot get straight answers from their representatives. Our congresspeople and senators prefer empty words and slogans to telling it like it is.

I cannot vouch for the total accuracy of the site the URL for which I give, but at least it points to specifics in the bill. You might want to read it for yourselves. You'll learn more from reading it than you will from your representatives in Congress.

CB said...

Glad you posted the above link. I was getting ready to do the same.

As the people of this great nation, we need to remember that We are our decision makers.

Healthy living is important, however we all know patients, who by no fault of their own suffer illness that carries a high price tag.

I have boycotted doctors/hospitals for years. Insurance became out of reach financially years ago. What happens when there is an emergency? Bad credit and years of pay back.

The system is one secured by fear. Fear of financial ruin is real. The alternative of government being our master does not seem to be the majick pill that will solve the woes. In fact, the consequence for this action will take a high toll on a once great nation.

What liberties are you willing to forego to have "guaranteed" healthcare.

Be careful what you wish for....

For example:

Sec. 163, Pg. 58-59 beginning at line 5 - Government will have real-time access to individual’s finances & a National ID health care card will be issued!
Sec. 163, Pg. 59, Lines 21-24 - Government will have direct access to your bank accounts for electronic funds transfer.
Sec. 164, Pg. 65 is a payoff subsidized plan for retirees and their families in unions & community organizations (ACORN).

Sec. 1442, Pg. 624, Lines 19-23 - Qualified Entities: “The Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.”
Sec. 1442, Pg. 623, Lines 5-10 - “Quality” measures shall be designed to assess outcomes and functional status of patients.
Sec. 1442, Pg. 623, Lines 15-17 - “Quality” measures shall be designed to profile you, including race, age, gender, place of residence, etc.
Sec. 1443, Pg. 628 - The government will give “Multi-Stake Holders” pre-rulemaking input into selection of “quality” measures.
Sec. 1443, Pg. 630-31, Lines 9-24, 1-9 - Those Multi-Stake Holder groups include unions and groups like ACORN deciding what constitutes quality.

Sec. 1601 (beginning), Pg. 685-699 - Increased funding to fight waste, fraud, and abuse. (Like the government with an $18 million website?)

Sec. 1801, Pg. 819-823 - The Government will identify individuals “likely to be ineligible” for subsidies. Will access all personal financial information.
Sec. 1802, Pg. 823-828 - Government sets up Comparative Effectiveness Research Trust Fund. Another bottomless tax pit.
Sec. 4375, Pg. 828-832, Lines 12-16 - Government will impose a fee on ALL private health insurance plans, including self-insured, to pay for Trust Fund!
Sec. 4377, Pg. 835, Lines 11-13 - Fees imposed by government for Trust Fund shall be treated as if they were taxes.
Sec. 440, Pg. 837-839 - The government will design and implement Home Visitation Program for families with young kids and families that are expecting children.
Sec. 1904, Pg. 843-844 - This Home Visitation Program includes the government coming into your house and teaching/telling you how to parent!

Full bill here:


Look at what is in the Bill!:

BE informed. Don't take either "sides" propaganda. This is our future.

CB said...

Here is the link, sorry it didn't post in the above comment

Richard said...

I have written my representatives in congress (both houses) encouraging them to "put their money where their mouths are" that is, if the health care reform they want the American people to buy into wholeheartedly is that good, change the health care plans that congress and federal employees have to conform to what they're proposing for the rest of the people.

That will do two things: 1) It will show the American people that congresspersons and senators genuinely believe that the legislation they've passed is in the people's best interest and 2) it will take us out of the Orwellian situation where "all Americans are equal, but some Americans [i.e., members of congress and federal employees] are more equal than others.

What we should be saying at town meetings, not shouting down our representatives, but being civil yet insistent, is that they level with us on the provisions of HR 3200 and that they include themselves in the reform. Put their feet to the fire.

Anonymous said...

How is all of this to be funded? Healthy lifestyle education, subsidized gym memberships, no denial of pre-existing conditions, no lifetime caps. Why doesn't anyone seem to understand that all this will cost money?

Then, how do you plan to enforce the "Healthy Lifestyle Choices"? Healthy lifestyles don't eliminate all of the causes of death that are attributed to bad lifestyle. Deaths occur - people do not live indefinitely. The largest contributors to cardiovascular and cancerous deaths (by far the largest two causes of death) are persons above age 5. This probably would not change due to lifestyle choices, you may gain a couple of years on your life, but you will eventually die, and chances are it will still be from one of these two causes.

Healthy lifestyles themselves tend to be under review constantly. Exercise is one of the few things that has been consistently part of a healthy lifestyle. Nearly every other possible lifestyle choice has gone through several iterations of healthiness.

Why is the public option so important? Why not simply open up more competition by not imposing some of the regulations about what has to be covered by health insurance. A real public option would be allowing companies to truly compete for people's money. Changes in a person's life will have an effect on what they feel is important to them. The same is true for all insurance purchases - auto, home, life, health. Currently, governments have so many restrictions and regulations on health insurers that there is very little flexibility in what can be offered to an individual.

Lee said...

Why aren't Chain E-Mails challenged here? When I see a message like "CB said..."

Look at what is in the Bill!:

BE informed. Don't take either "sides" propaganda. This is our future.

I took his advice and come to the conclusion the only thing I agreed with was his appeal to be informed.

My request to everyone who reads his post is to go to
before you make up your mind on anything..

Where Richard said he could not vouch for the accuracy of the site he recommends - he said a mouthful.

A site that I and everyone that checks facts can vouch for is the one I recommend.

Barbara Ruth Saunders said...

One of the problems with the whole public discussion is lumping together dozens of different issues, each of them complex.

Ten years ago, I worked for a health club. We had the best employer-paid coverage I have ever had, presumably because our employee population was young, fit people who exercised for a living. An employee in her mid-thirties got a brain tumor, which eventually killed her.

The insurance company TRIPLED the premium, effectively forcing the company to seek another policy. Of course, the claims history meant that the next policy wasn't so great.

"Taking responsibility" can't prevent the random tragedy of a brain tumor in a 35 year old woman. And how does "taking responsibility" play into the cases of healthy young-middle-aged people who do all of the right things and are denied any insurance for anything because they have minor, self-limiting, and inexpensive conditions.

Richard said...

Thanks for pulling me up short. I very much appreciate your giving a more reliable analysis than the site I had referenced.

With all the misinformation being dissemimated, it's good that someone was more alert than I.

Good job!

Anonymous said...

Rampant Fraud from the Right Wing. I'm re-posting this link. Please watch the interview of Wendell Potter. He speaks the truth. We need congress to vote for a Public Plan. Right now, the insurance companies are salivating at the prospect of having the 50 million un-insured to be mandated to buy health insurance. We need a Public Plan so that private insurance companies will have to compete and lower their premiums. Wake Up People! Do Something! Please watch this video interview of Wendell Potter and then contact your congressma­­n/senator­, urging them to support a Public Plan. Also, feel free to copy and re-post the video link below and/or my message and place on all comment boards on HuffPost. We need to get more and more people to watch this interview and effect change. Currently, the Corporate Beaurocrats and their Lobby are taking over town hall meetings and influencing the general public to be scared of a Public Plan. We need to take control of this debate and show the Real Truth. If you haven't seen Bill Moyers' interview with Wendell Potter, former PR executive for CIGNA, I strongly recommend it:

herm said...

Here is one of the main reasons why healthcare is so expensive:

When John J. Gilligan of Ohio was running for Governor in 1970 and during a TV interview, his father was asked why healthcare was getting so expensive? His comment was, I am on the board of BLUE CROSS & BLUD SHIELD and after what I am about to say, tomorrow morning I might not be on the board of directors or at least I won’t get nominated again when my term ends.

Gilligan’s father said the AMA, the doctors and the medical profession want to get paid in money instead of a barter system or have to wait to collect money due.

He said, years ago the medical profession wanted to get healthcare SO EXPENSIVE that people would have to buy health insurance. They lobbied our congress and senate and eventually got their way. They talked (lobbied) health insurance to corporation chiefs and through TAX BREAKS, finally got corporations to give healthcare to salary workers and then eventually to the common laborer. Now we are all paying dearly for this.

He went on to say, I feel we are simply a COLLECTION AGENCY for the doctors and hospitals.

Looking at his last statement, I feel the INSURANCE INDUSTRY is simply a MIDDLEMAN absorbing a huge amount of healthcare dollars. I don’t know how to find that interview, but it would be very enlightening to read and then see how things have progressed to the present day.

Now…. Who do you think shoved EXPENSIVE INSURED HEALTHCARE down our throats?

Just think of how much money could be placed back into healthcare if we can eliminate the “Middle-Man.”

Think about it. With a public option your doctor bills the government just like he does with Medicare, no middleman.

Richard said...

I pass along a letter from the American College of Surgeons that was sent to a colleague of mine. I have omitted his name, but if you want to check the authenticity of the letter, go to the ACS site.

The following statement from the College was issued to media across the country today:

Statement from the American College of Surgeons Regarding Recent Comments from President Obama

CHICAGO--The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.
Three weeks ago, the President suggested that a surgeon's decision to remove a child's tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what's right for the patient.
We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President's remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 76,000 members and is the largest organization of surgeons in the world.


L.D. Britt, M.D., FACS, Chair of the ACS Board of Regents
John Cameron, M.D., FACS, President of the American College of Surgeons
Andrew Warshaw, M.D., FACS, Chair of the ACS Health Policy and Advocacy Group
Christian Shalgian, ACS Director, Division of Advocacy and Health Policy

Constantine said...

When Trump is getting into the Healthcare/nutrition business its clear, we as a nation are really sick. As we die there is money to be made beyond Atlantic City. One cannot hide from the facts. That's the way it is. So its time for healthcare reform, Now or Never! Youtube P1915.

Anonymous said...

I have to comment on the cost the doctors criticizing Obama about getting the cost of a leg amputation wrong. The surgeon may only get $740 to $1140 for the procedure, but I'll bet that is only a tiny part of the bill. What happens is that the doctors and the hospitals split the bill up into pieces, where you get one bill from the doctor, one from his group, one from the hospital, one from the anesthesiologist, one from the anesthesiologist's group etc.

When I broke my leg in the 1990's I had to have X-rays all the time and they only cost $25 apiece. Two years ago, I had one X-Ray and it cost $600. $100 for my doctor to refer, $100 for the X-Ray technician, $100 for the X-ray technician's group, $100 for the radiologist, $100 for the radiologist's group,$100 for my doctor to read the report.

myRay ::: Dr Michael Benjamin Mb.Ch.B. BSc. said...

I am an Israeli Doctor and health care administrator. I was UK born and bred. I know two 'single party' payment systems well.
Basically you are talking about two things:
1. Universality of care: UC cannot be offered without a bureaucracy. When this happens the whole game changes. Instead of negotiated optimum care [you pay what you can and get the best for your money] you receive third party decided upon optimal care. A take it or leave it one level standard.Be of no doubt that anyone in a UC system really dislikes it [both patients and staff].
2. Rationalisation of payment. Right now you are being sold a bill of goods that a co-op will be cheaper. It will not. It faces all the basic costs but won't make a profit. Probably not but due to the inherent inefficiency that they all have be sure that they will make a loss & be eventually subsidised. They will provide the worst of all words no control and no efficiency. As the worst risk uninsurable sediment to the co-op the non co-op will attract the healthy and cheaper patient. So you will see 'fluff-gimic medicine' aimed at the healthy and the ill encouraged to get cover with the co-op. The co-ops will collapse and ----well your experience with housing should give you an insight.
So what is the answer?
Incremental change. Reduce the costs that you can. The government should demand that every policy has a an alternative of dealing with mal-praxis. One being arbitration. The arbitration board would establish quality of defensive medicine and set fees for negligence.A patient can choose and pay for the cover he wants: 'Sue and pay' or 'Sue free and rational'.
Make insurance portable. This would encourage competition and make the cover more competitive.
Realise that there must be a gatekeeper. He should be the family doctor. This means changing the whole delivery system and mentality. This takes time.
for more detail see my blog:
Unfortunately the biggest head ache seemingly is one that I am not sure that you have looked at. At some point you will have to not only assess the economic soundness of the insurer to provide but guarantee its solvency when it collapses. How do you do that? What do you do when it collapses? This is more relevant when the co-op becomes a player.
Unfortunately both sides of the present debate are very correct. So do this change slowly, surely and cleverly. Check what you are doing at each stage. Above all take heed to concerns -- don't politicise and deride them.They are genuine and relevant
Dr Michael Benjamin

FaithfulinPrayer said...

I agree with all your ideas except #2, the Public Health Plan. We already have government-run health plans. I believe we should revamp and use them. Medicaid has two plans for children called CHIP. One of the plans is free, the other costs about $50 a month. Offer those to more people. I would also like to see a Medicaid Supplement for people who work but have such a high deductible that they do not go to the doctor ever.

There is so much mis-information out there about the health care bill just like one of the comments from "CB" here. I am reading the healthcare bill (h.r.3200) and detailing it at Come read what it really says and let me know what you think.

Anonymous said...

I wish we could have some Ross Perot style charts and honest debate. A good place to start is the Frontline piece you mention. that is available to view online - very non polemic.
As the crazyness in Washinton is evolving i am becoming more synical and find myself agreeing with Matt Taibbi in his Rolling Stone piece "Sick and Wrong" Sept 3 issue.
We pay 16% of our GDP vs most countries pay less than 10%, cover everybody and have better outcomes. This leaves 6% to bribe our politicians on both sides of the isle - so far quite effective atobfuscating the real issues.
The public is like the frog in water rising gradually to a boil - only those with unforseen health issues feel the boil instantly but it is too late to jump out - the game is rigged.
The latest ploy is to somehow require for profit insurance to not use pre-existing conditions - do you really think they will welcome someone with a million dollar malady into the warm arms of their insurance - it just ain't going to happen that way and be for-profit. They will find a way to dodge them, or if they get them they will figure another way to drop them. Risk mitigation requires huge pools to average the cost - with single payer being the front runner in this regard - or some similar mandate.
Another thing i don't understand is for someone to explain why people need different plans. We all need more or less the same remedy if we get sick - Ask the rich executive why he needs better treatment than the McDonalds worker - health is a universal need.
Another ploy i hear is that we can fix it by allowing you to buy insurance from any state to help competition. I don't think it would make a difference except making it more difficult for states to regulate across borders. This seems like a diversion not a plan.
Another thing i don't hear is how our high cost of healthcare makes our businesses less competitive worldwide.

There are big issues here -somehow i hope we can have a national debate and reach some concensus based on facts.

Your article was a good start.