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Yet another plea for action on excessive health care costs


The following is a copy of a comment I made to an article in the New York Times online.  The comment was in response to another comment requesting three actions to help address the excessive cost of medical care in this country.  I repeat it here because when I finished it, I realized how important it was.  I added a few things in square brackets that wouldn’t fit in the NYT’s 1500 character limit.

I am a retired physician. Here are the three actions that will save the most money: (very hard to accomplish, but worth it.)

1)single payer universal health care. (This involves rationing, electronic records, and many other improvements)
2)eliminate the “fee for service” system: change over to salaries for all health care providers.
3)crack down on the drug industry: have the single payer buy all the drugs and demand discounts for volume.

Note that I am ignoring malpractice, fraud, and a host of other issues because they represent only a small portion of the problem.  [Comprehensive reform can address these issues as well, especially because they would be easier to accomplish.]

Making people pay more (large copays and deductibles) will only make the problem worse because (as studies have shown) people economize inappropriately when they have to pay more for their care. They wait too long to treat problems for fear of the cost, and the problems are worse and cost more to treat when they eventually do go to treatment. Keep in mind that in Europe, many countries have minimal to no copays, and the overall costs in these countries are half what they are here.

This is a subtle and difficult problem and I don’t believe it will see improvement in the near future because there are too many industries sucking money from the business: pharmaceutical companies, insurance companies, physician’s group (AMA), device manufacturers, etc.  [Medicine has a reputation as a cash cow, so it is very attractive to entrepeneurs, rent seekers, and other hangers-on.]

While I’m at it, I recommend that we throw open our borders to immigrants, especially young workers, to revitalize our Social Security system (think about it.)  [The basic problem with Social Security now is that there are too many older workers getting ready to retire and not enough young workers signing on to pay into the system.  Look it up, this is verified research: this is the real problem.  In addition, eliminate the cap on salaries subject to the SS tax: it’s a flat tax, and having a cap makes it regressive.  Making the retirement age older will NOT help, and is unfair to those working low paid, strenuous jobs who are completely worn out long before age 65.]

I could add a lot of additional verbiage to this comment, but I think that it is pretty good by itself.

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