| Candidate Obama promised to bring a "change | | | | incentives for doctors to treat patients according |
| you can believe in" to Washington politics and the | | | | to good medicine protocols. A doctor who refuses |
| way government has been doing business for | | | | to take a Medicare patient because of poor |
| decades. These main two selling points brought | | | | reimbursement is in fact raising the cost for that |
| him into the White House. One year later, | | | | patient when he becomes too ill and seeks care in |
| fair-minded liberals as well as conservatives would | | | | the emergency room. A secondary effect is that |
| admit he failed in either one miserably. | | | | doctors are getting out of the field that has not |
| Failure to succeed on a promise would give any | | | | provided a satisfying career of practicing medicine |
| President a bad grade; but in failing to bring | | | | for the patient. Fewer doctors means less care |
| change into Washington politics, and hence get his | | | | which in term means poorer health outcomes |
| health care agenda passed in the middle of a | | | | therefore higher costs. It is a vicious circle that |
| democratically well controlled House and Senate, | | | | can only be stopped with sensible reform. The |
| President Obama displayed an inexcusable | | | | same goes for Medicaid. Poor management and |
| performance, one that in a competitive, profit | | | | reimbursement induces massive inefficiencies and |
| maximizing corporation would have cost him his | | | | skyrocketing costs. In the end, it is the patient |
| job by now. The reason his failure is so profound | | | | that suffers and who in tern adds to ever rising |
| has to do with his luck of understanding of the | | | | costs and more inefficiencies. |
| key components of the problem at hand. The luck | | | | One way to fix Medicare is to continue the |
| of understanding of these fundamental | | | | existing privatization that allows private companies |
| components at this time of economic uncertainty, | | | | to compete and the patient to bear some of the |
| begs the need to question Mr. Obama's | | | | responsibility. Our research has shown that the |
| inexperience in governing, as well as his inability to | | | | doughnut hole may indeed be a black hole that |
| recognize the issues at hand towards deciding on | | | | induces patients to switch or avoid therapy |
| a course of action and bringing forward sensible | | | | altogether, which in tern produces poor outcomes |
| arguments that people can believe in. | | | | and hence higher costs. However, if the model is |
| With regards to healthcare reform, the issues | | | | revised the patient can still bear some of the |
| Americans are faced with go beyond covering the | | | | financial responsibility and hence use the system |
| uninsured and bringing shame to insurance | | | | wiser, but he is not faced with such a catastrophe |
| companies. Certainly the above have to be dealt | | | | to be making unwise treatment decisions. |
| with but the health care issue is not a poor man's | | | | The uninsured pool is made of two cohorts. The |
| prerogative. Every family, from poor to middle | | | | poor and the...not so poor who are willing, or |
| class is faced with exorbitant health insurance | | | | forced to game the system. The two uninsured |
| costs while at the same time incremental health | | | | groups are: |
| benefits have not kept up with technological | | | | 1. Uninsured because of poverty, and |
| progress, hence have not been realized. It is not | | | | 2. Uninsured because the proposed legislation |
| unusual for a middle class family to be paying one | | | | would allow one to game the system by avoiding |
| third of its income on health insurance only to be | | | | (high cost) insurance and only paying for it on the |
| asked to also pay co-pays, coinsurance costs, etc. | | | | way to the hospital |
| At the same time, it is clear that the existing | | | | Instead of forcing people to buy insurance (by |
| reimbursement system has stifled technological | | | | imposing a penalty which silly enough is less than |
| innovation in medicine and diseases like cancer, | | | | the cost of insurance), incentives should be |
| HIV, etc., are still around after decades of | | | | provided to induce wise and parsimonious |
| expenditures in research and investment in human | | | | utilization of resources. People are not criminals |
| capital. Relative speaking, when it comes to health | | | | and should not be treated as such by imposing |
| care the US is the most technologically advanced | | | | severe fees/penalties to induce them to a certain |
| nation, but nationally, we have been making baby | | | | behavior; in general, people act wisely and will |
| steps in terms of dealing with serious illnesses. | | | | always seek behavior that seems fair for the |
| So what is the way out of this mess or the best | | | | benefit received. Health accounts that are set |
| way to fix "the problem" in health care? For one | | | | aside to use in time of need should not be "use it |
| thing we have to accept the fact that this is a | | | | or lose it" types; after all, who wants to set aside |
| "universal" issue and not an issue just for the poor | | | | thousands of dollars per year, on top of insurance |
| and uninsured. Not accepting this as the main | | | | premiums, just to cover an emergency that may |
| problem and trying to fix the issue by pouring | | | | never occur? I know of many people who think |
| dollars indiscriminately -over one trillion of | | | | this is insane and counterproductive. |
| government debt, is not only unwise but rather | | | | The proposed legislation approved by Congress is |
| irresponsible as well. One has to recognize the big | | | | basically dead and members of Congress, be it |
| cost components that contribute to this problem | | | | republicans or democrats, have been |
| and deal with all of them. The big components are: | | | | disassociating themselves from it. The truth of |
| 1. Medicare & Medicaid | | | | the matter is, these proposals were concocted |
| 2. Reimbursement and patient responsibility | | | | behind closed doors, with brides and kickbacks |
| 3. Consumer cost and incentives for better | | | | and no one can trust them. For a bi-partisan |
| utilization of health resources | | | | proposal and a change people can believe in, the |
| 4. Uninsured | | | | existing proposals should be thrown out and new |
| Medicare reform is necessary in order to provide | | | | ones should begin from scratch. |