OK, I guess I lied. I said I had all the answers and as I researched and developed this I realized that maybe I indulged in a little hyperbole. I do believe the fifteen points contain some valid solutions, and a framework for solving the others, but there is no real “quick fix” for the Gordian knot of health care or it would have already been resolved. And, as I hope I’ve made clear, it needs to be approached on many fronts simultaneously to have any hope of getting a handle on it without making it worse. So, we’re back to health care as a sickbed. We don’t live in a Harry Potter world where a wave of a wand and the incantation “Salubrius maximus” will shrink the bed or provide a king-sized sheet. We have to get down to basics. We need to increase efficiency dramatically through better information flow and ruthlessly excising redundancy, we need to explore the most effective diagnostic and treatment options and realign our approach to treatment both as physicians and patients, and we need to understand that, even with these efforts, some form of rational rationing is inevitable. There needs to be a mandatory insurance requirement for any system to work: the many who are well must support the fewer who are sick, or the well cannot expect the same when they, barring death, inevitably join the ranks of the ill. The government’s role should be limited to regulating only when and where it must, to protect the system from abuse and to require participation by those that wish to take without contributing.

Well, I’m done. If I’ve accomplished nothing else, I hope I’ve stimulated another round of debate and expanded it beyond the sole question of whether and to what extent the government should inject itself (pun intended) into the melee.

For President Obama and Congress I have two final words: “Slow down.” This is too large, complex and important and issue to set artificial deadlines only weeks away.

For the rest of you, whether you agree, disagree, or think I should be locked in a rubber room and the key disposed of in a jar of muriatic acid, I think we can all see eye to eye that doing nothing is a recipe for disaster.

I’d love to hear your thoughts. Keep them polite, pithy and perceptive, no matter your view.  Acrimonious tirades should be avoided, as I’m a delicate soul. Should you feel the urge to submit one, have a glass of (good) wine first. And take an extra sip for me; after all, studies show that moderate alcohol intake is good for your heart.           


Next: Medical Peeves, or Things I’ve Heard That Make My Blood Boil


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