For over a decade there have been reports of the exponentialing growing cost of medicare and the need to reign in costs.  The solution: expand the program by at least 30 million people! The cost projections done in the ’60′s proved to be wrong by a factor of 100.  That is the true cost 20 years down the line was 100 times more than projected. With some creative math, we are told that the current health proposal will cost $1 trillion, an amount that we don’t appear to have.  In reality it will cost more.  Who knows how much more? $2 trillion? $10 trillion? $100 trillion? 

Medicare has been increasing well above the cost of inflation since it began.  The rhetoric indicates that there will be savings through better preventive care, decreased errors due to investment in electronic records, and price controls.

Preventive care:  I live in a rural community.  The people or largely poorly educated and overweight. We have many smokers. Even with free care, many of them would not go to the doctor for health maintenance.  If they did, there is no guarantee they would do what they were advised to do.  Eat less, exercise more, quit smoking, take medication for your hypertension, diabetes, cholesterol… Decreased cost (for the particapant) will only go a little way toward improving the health of the nation. 

Errors: A computer is a tool dependent on the human operator.  Electronic medical records (EMR) will not eliminate human error.  Having used EMR at the hospital and now at a private clinic, I don’t think it will reduce cost or errors one bit.  All of the data is entered by people.  It is just as easy to click the wrong box as it is to pull the wrong vial off the pharmacy shelf. EMR will make it easier for government bureaucrats to measure compliance with government edicts and deny payment for not complying.

Price controls don’t work.  Never have, never will.  Efficient pricing of capitalist markets allocates resources rationally.  Health czars don’t.  They assign benefits to the cause du jour, perceived areas of need, and to friends who enrich themselves with our tax dollars and pay the favor back with campaign contributions.

The physical and financial health of the nation are about to get worse.  We need reform that  can help contain cost and improve health.  Tort reform, insurance reform, tiered care.  Repeal EMTALA.  Make people pay something for their care.  Until people take responsibility for themselves–their health and welfare–cost will continue to soar.

Where will it end?  Will the players be allowed to pray before the game?  Will they be allowed to point to the heavens after a touchdown?  Will they be allowed to wear crosses around their necks?  Can they still attend church during the regular season, or, as representatives of the high school football team and the school, would this be considered an endorsement of Christian values by an agent of the school district?

 America is a Christian nation.  We fled religious persecution and founded the American colonies.  Now, Christians are persecuting themselves in the name of religious tolerance.  The Christians are the tolerant ones.  We accept other religions, even when they do not accept ours, even as they undermine the Christian underpinnings of our nation at every turn. 

 The majority of Americans are Christian.  Although the non-Christian minority should not be required to practice Christianity, they should certainly be tolerant of it, just as Christians should be tolerant of belief systems that can coexist with western values. 

 American values are based on Christianity.  Acknowledging the origins of our nation doesn’t undermine the nation, it strengthens it.  It reminds us that our values were not always accepted, that we were persecuted, even killed for believing in something that the state did not agree with. 

 The state is conflicted.  Though it was created on Christian principles with Christian references, slogans and symbols, it wants to be neutral to all Americans.  At the same time it is ruled by the majority.  That majority is Christian.

 Proscribing the voluntary display of religious quotations tramples freedom of speech and freedom of religion for the majority of Americans.

No matter how much the nation produced, the local, state and national governments’ desire for more of your funds has never diminished.  Even during the recent boom, our governments largely ran at a deficit.  They were irresponsible when they were flush with cash and they are behaving even more irresponsibly now that they are broke.  We need to take the power and the money out of government’s hands.  We don’t need more government programs, more assistance, and more regulation.  We just need the government to get out of the way.  Then watch how quickly America solves its problems.

As a doctor I am terrified by the latest socialized healthcare proposals.  The current administration would have us believe that the government can deliver healthcare more efficiently and less expensively than the private sector.  The government is not new to healthcare.  Medicare and Medicaid were enacted in 1965.  There is a 40 year history proving that government healthcare is not efficient or cheap.

That said, I am not opposed to the concept of universal coverage.  It is a laudable goal, but there will always be a segment of the population that remains without healthcare.  Steps can be taken to increase healthcare coverage and control cost.  First, define goals.  Second, define priorities.  Third, allocate resources to the project.  Fourth, do as much as you can, using the priorities and goals as a guide, with the resources you have.

The stated goals are to achieve coverage for the most people for a tolerable price.  According to government statistics, there are approximately 45 million uninsured people in America, 15% of the population.   45 million people are on medicare and 56 million people are on medicaid.  The government currently provides coverage for a third of the population.  This would increase to about half the population if all of the uninsured were covered under a new or existing government plan.  To achieve the goal of universal coverage, let’s assume that everyone who does not have health insurance through employment, marriage, or private purchase will be included in the new plan.

What should be covered?  Basic services such as annual doctor visits, immunizations, prescription medications, radiology services, specialty services, and emergency care need to be offered.  The specific services offered and excluded will need to be clearly defined.

Any doctor reading this will state that cost savings cannot be acieved without malpractice reform.  Defensive medicine requires the application of the latest test for every minor problem.  Without malpractice relief, there will be no ability for doctors to reduce the inappropriate use of such testing.  There will be no ability to reduce specialty consulations.  There will be no ability to limit formulary prescription.  Essentially, the nation will be committed to the most expensive healthcare imaginable.

EMTALA needs to be radically changed.  The emergency room is heavily abused by the uninsured and government insured population.  There needs to be a mechanism to drive this population to their primary care physicians, designated clinics and hospitals.  The emergency room needs to be able to turn people away when they present with non-emergent problems.  This will be crucial when wait times to see primary care physicians increse under government healthcare.

People need to be retrained.  If the resources are limited, wait times will be longer.  It will take longer to get a doctor’s appointment, special tests, specialty referrals, etc. 

Doctors will need to adjust to the new system.  We will need to wean ourselves from expensive tests that usually confirm the clinical diagnosis.  This will be an adjustment for many doctors.

Some services won’t be offered.  The plan will have to determine what resources remain after providing primary care, drugs, immunizations, and other essential services.  Some services that people take for granted will not be available through the government plan.  Eliminating this restriction destroys the budget.  This will be very controversial, but it is absolutely imperative.

Now, I have offered some guidelines that will help define the nature of the healthcare problem and begin to outline a solution.  I am opposed to any plan that does not clearly define the goals, priorities, budget, and limitations.  The consequences of an ill conceived, government healthcare plan are decreased quality of care for the nation.

The government has not proven that it can control cost.  For years it has been clear that the Medicare entitlement was too expensive.  It doesn’t pay for itself now and there is no plan in place for it to be adequately funded in the future.  Yet, we are to believe that the government will do a better job with more people covered?  The phrase,”We are losing money on every sale, but we plan to make up for it on volume,” comes to mind.  If we apply a bankrupt model to a new larger system, the new system will surely be more bankrupt than the old one. 

The VA system is the government model.  The VA moves slowly, often lacks or does not utilize the latest technology, and uses a limited formulary of medications.  Our vets are getting great care… for 1985.

A social health plan will : 1) dramatically increase the deficit 2) roll the standard of care back a decade or more 3) stifle innovation by removing money for and financial incentive from research and development 4)reduce the number of and productivity from doctors.  The costs are too high.

How many jobs would $219 billion create?  If only half of it went to salaries, nearly 1.1 million $100,000 per year jobs could be created.

Those are numbers even a politician can understand.

It is time to stop funding anti-American governments in Russia, Venezuela and the Middle East with our oil money.  We need to develop our natural resources and create jobs in the United States. 

1. http://www.eia.doe.gov/basics/quickoil.html

2. Protect the environment.  We are more environmentally conscious than the nations we import from.  We would protect the land, the wildlife and the workers .  It is environmentally responsible to develop our own oil.

3. Stop financing hostile nations and terrorists.  Oil finances tyrranical regimes in Russia and Venezuela.  It buys mercenaries and guns for terrorists.  It is time to stop funding our enemies.

4.  Reduce spending on the war on terror.  By cutting funding to our enemies, there would be fewer to fight.  Perhaps this war would end.

5. Advance western ideas.  The nations that live on our oil money do not respect democracy, free speech or women’s rights.  Billions of dollars in oil profits allow oppressive regimes in Russia, Venezuela, and Iran to stay in power.  By keepign the money in our economy, we can direct the profits to advancing our values.