On September 30th of last year I gave a list of 15 things that, in my opinion, needed to be implemented to have a hope of untangling the heath care mess. Instead, thousands of pages of proposed legislation rose like a miasma from the political swamp known as Capital Hill. So, on February 1st I whittled it down to 5 things. Instead, the denizens of the swamp passed said legislation. So now, I’ll make it simpler.

In no particular order, since they must be implemented simultaneously, we need:

  1. Tort reform. This is not included in the current bill.
  2. Require interstate competition from insurers. As far as I’ve been able to determine, the only mandate for insurers  is that they reduce exclusions.
  3. Change the current culture in the medical community toward diagnosis and treatment of disease. This isn’t addressed (except by me in my February post).

Anything that doesn’t tackle at least these three things is smoke and mirrors, and the old game of making promises (more people covered, no exclusions of pre-existing medical conditions, etc.), while laudable, are as empty as campaign promises unless there’s a real way to pay for it. (Witness the impending demise of Medicare and Social Security.) Right now, we do it by borrowing from paragons of freedom like China, and the unborn. I’m grateful that my children and their children are willing to support my future health care—they have more charity in them before drawing their first breaths than many of us who have produced more than our fair share of carbon dioxide.

The days of federal Ponzi scheming have to end. The American people will decide at the ballot box.


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  1. Mark Baird Says:

    “Witness the impending demise of Medicare ”

    Do you honestly believe that seniors would be able to afford health care on their own? Why did the free markets not find a solution for this in the 60’s? As for tort reform. I hear much talk but very little empirical evidence but rather see more empirical evidence that shows this is exaggerated. This is understandable because being sued is an emotional issue and when emotions are involved their are exaggerations.

  2. David Puro Says:

    As laudable as universal health care is as a goal, it remains a goal and not a reality unless the resources exist to provide it. And resources do not materialize with promises. If we are to provide more care for more people who will live longer without courting insolvency we must do things that will increase our “bang for the buck.” In my opinion tort reform is a necessary but not sufficient part of this reform. I don’t recall health care being insolvent in the 60’s, but it will be shortly. Divorcing the patients from the cost of health care and limiting competition between insurers, both “non-free market” interventions, contribute in a major way to the current problem. Fixing this is also necessary but not sufficient. The market place can be tough, but in my experience, over the long haul, it’s smarter than our legislators who, rather than trying to do better than the marketplace, should be spending their time figuring out how to keep it from being gamed and corrupted.

  3. Dr. Tom Bibey Says:

    You might enjoy my book, “The Mandolin Case.” The subtitle is “Country Doctors, Honest Lawyers, and True Music.”

    The story is a medical legal mystery solved by local musicians. It has many lessons.

    Dr. B

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