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Health Care for Everyone: There Is No Quick Fix

Hayden Hollingsworth
Hayden Hollingsworth

Most believe that everyone should be covered by health insurance.  From that point on, no one agrees about anything.  That there are huge arguments about what form the plans should take is reassuring.  Rather than getting some rush-to-judgment, poorly- thought-out scheme, Congress has had the good sense (how often do you hear that phrase) to avoid presidential pressure to get it done by next week.  It has taken a half century to arrive at our current mess; it realistically may take decades to unravel the Gordian knot in which we have tied ourselves.

There is plenty of blame to go around:  The private insurance industry, the medical profession, the pharmaceutical companies, organized labor, our national penchant for suing when things turn out badly, product liability lawyers, for-profit medical care, and a host of others.  There is one participant that is rarely mentioned when we talk about our health care problems:  You and me.  Remember the line from Walt Kelly’s comic strip, Pogo:  “We have met the enemy and they is us!”

Our attitude has a lot to do with the morass we’re in, not just with health care, but with the economy in general, and our national priorities.  In the distant past we came to believe some central things about what we want:  We want it when we want it and we want it now.   Of course, I want the same for everyone . . . right after I get mine.  In addition to that, and this is a most important part, we don’t want to give up anything (especially money) to get it.  The history of our sense of entitlement would make an interesting dissertation topic.

Only those who believe in The Fairy Godperson (let’s be politically correct here) think there is enough money to finance universal health care without major sacrifices on every front.  Pundits speak about mega-savings from preventive care; those would come in about a half-century and probably not then since people would be living longer. Fraud and abuse in the private sector, to say nothing of the government, accounts for a trivial amount.  Malpractice falls into the same category. Rationing services and means testing?  Don’t even think about it.

Duplication of facilities and services has long been a problem and still we do it.  There are more CT, MRI, and PET scanners in Roanoke than found in most developing nations!  If hospitals agree to share facilities (which they rarely do) then they come under FTC scrutiny for suppressing competition.

As a physician, I know the temptation of ordering extra tests to protect against malpractice; but I also know that I got paid for doing it. In any given year, my large group practice supplied hundreds of thousands of dollars of free care.  It wasn’t free just because we doled it out gratis; it was given to people who couldn’t / wouldn’t pay or were uninsured.  We never used a collection service . . . we just wrote it off the books.  An amazingly simple way to get care for uninsured and indigent patients would be to give the physicians a tax credit for all the patients they see who meet criteria for a subsidized system.  Even a 5% tax credit for unreimbursed care would be welcomed.   For a hundred thousand dollars of care the IRS would be out of only five thousand dollars of tax revenue.  I mentioned this to a congressman who instantly replied, “I don’t like tax credits.”  So much for that sensible idea.

The money for the system will have to come from somewhere and there will be sacrifices.  This is the smoke and mirror phenomenon; believe it is real at your own peril. Benefits will be reduced; larger deductibles are inevitable as are larger co-pays and restriction of covered services.  Everyone knows that, but no politician talks about it.  Is it time to consult the Fairy Godperson?  Every interest group, my subspecialty included, screams bloody murder when our ox is set up for goring.  Until we get over the national notion that we can have everything at someone else’s expense, we will continue down a road to disaster

I suggested long before this became a crisis that the President should appoint a multi-discipline blue-ribbon panel to study the problem for two years then come back with recommendations. We all remember how the Iraq Study Commission did not cause the administration to even blink, so why should this work now?  At least it would get it out of the political arena and keep us from stepping off the precipice without knowing where the bottom lies.

By Hayden Hollingsworth
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