I expect, then, that he runs his practice strictly on a cost-reimbursement basis. After all, any money he or his staff take home at the end of the day to pay their mortgages or to feed their families or to buy cars and gizmos or to pay for entertainment — whatever money they take home to live their lives — comes from profit.
Jack Connors, Jr. argues (12 Jun) that the current revenue surplus in Massachusetts should be spent on increased Medicare reimbursements rather than being returned to the taxpayers from which it derived…using them to increase reimbursements for Medicare – or to fund benefit increases for any other entitlement program – is the worst possible use for the money.
Every once in a while a study is released comparing health care in the United States to health care in other countries. Despite the fact that we are the wealthiest nation in the world, and that we have one of the most technologically advanced health care systems in the world, there are inevitably some measures by which we lag other developed nations. We have come to expect that: no one denies that our health care system has problems with cost and access; and no one denies that there are certain groups within our society – bounded by poverty and self-destructive lifestyles – for whom our health care system is woefully inadequate. Those are problems we need to address – and solutions upon which so far we cannot agree.
But when by some measure our health care system trails the undeveloped world that attracts attention.
A recent report ranked the United States behind Cuba in infant mortality. Nicholas Kristof of The New York Times used that fact as a springboard for a broad and derisive critique of our market-based system. I agree with much of his diagnosis (and disagree with much of his prescription), but oddities in the way infant mortality is calculated in various countries makes it a dubious and slippery statistic upon which to hang a robust assessment of our current performance.
If we want to make drugs affordable in the third world, we must find a way to rein in the health care advocates who would use that as a moral platform to transform the American and European markets. Protected from such a threat, the drug companies would, I’m guessing, cooperate. But as long as Americans agitate to be treated – at least for purposes of pricing – the same as their peers in the marginal markets, the drug companies will do all they can to protect their domestic profits – which ultimately protects the R&D pipeline that benefits both the first and third worlds.
Every day print and television news organizations bombard us with the results of studies purporting to prove something profound about the effects of public policy, most contradicting some other studies reported last week. The election we just endured brought us a blizzard of conflicting statistics and analyses presented by the candidates and repeated by the media. Almost every advocacy organization now solicits and publishes studies showing – surprise surprise – that their particular policy agenda would be the best thing ever if only we would allow them to implement it. How are we to sort out the good from the bad in this barrage if your reporters will not present us with enough of the underlying information to make an informed evaluation?
The issue of abortion is once again forming the backdrop for the political show of our election cycle. And, as for the last thirty years, it is the bogeyman in the shadows, obsession of the few, ignored by the many until it is needed by politicians to frighten voters when they seem to be happy with the opposition. Abortion is universally recognized as divisive and intractable, a subject to be used for advantage among partisans but avoided in polite company, a fuse you can light but cannot control.
I started this book by announcing I knew how to reform the health-care system; it seems appropriate, then, that I end it with my health-care reform proposal.
Finally, to your warning about the eventual overreaction, to everyone’s detriment, to the creeping problem of general, portable access to health-care: I concur, and have for a long time. I have described this as the revolt of the officially voiceless: people with reasonable, legitimate, but inconvenient concerns – over access to health care, or over welfare, or over affirmative action, or over discrimination, or over campaign financing, or over free speech, or over taxes, or over regulation, or over some other issue – are told by the politicians, by the press, by academics, by the arbiters of social norms that they are heartless, or bigoted, or ignorant, or unreasonable, or unrealistic, or hateful; they are told that their concerns do not really exist, or are parochial, or are irrelevant, or must be borne with stoicism on behalf of some greater good; they are told they are unworthy of attention and respect; they are told, in effect, to shut up. And they do shut up – while their problems fester and swell, with animosity added to inconvenience – until they are, in the over-used phrase, “Mad as hell, and not going to take it any more.” And then we all suffer as the sledge-hammer solutions born of this groundswell of frustration create new problems and new animosities.
I am writing to you as perhaps the last hope for sanity in the debate over health-care reform; despite my California address I am a native Granite Stater and my respect for both of you predates your current activities on behalf of the Concord Coalition. I, as most people, have become concerned about the direction in which the debate seems to be moving. Because of your commitment to weaning the American public, politicians, and government bureaucrats from the trap of entitlement programs I thought you might have a special interest in what becomes of this potentially gargantuan new entitlement program into which we seem to be plunging. It is my hope that your influence and straight talk may yet prevail over the politics dominating the discussion to date.