Let the "Historic" Debate Begin

November 20 - When the Senate votes tomorrow whether to engage in further health reform steps, the stage is set for an historic debate. Before we engage in this debate, let us be clear what this debate is about.

It is about,

• the balance of power between government controls and individual freedoms.

• how to make health costs for government and individuals “ sustainable" and how to manage those costs for perpetuity.

• cost controls and how government may be forced to adopt techniques of private plans to limit fraud and abuse and expenses of paying for pre-existing chronic disease and experimental drugs and procedures.

• use of statistics to limit and manage costs versus individual needs and expectations - there is no better example of this conflict than the current flap over mammography guidelines suggesting delay to screening until after age 50.


• the status of the United States as a “moral nation” and whether universal coverage should be the leading indicator of that morality.

• who should care for the sick - government bureaucrats or physician and nurse caregivers.

.whether the United States needs a public option, an alterntive government plan, when 1300 private plans are available and await to opened across state lines for competitive bidding.

. whether is the obligation and duty of the federal government to help subsidize care of 62% of American families making up to $88,000 each year.


• the constitutionality of government to impose mandates on employers and individuals who do not buy insurance and the right of government to fine or imprison non-payers for tax evasion.

• power of government to burden states with Medicaid expenses state budgets cannot tolerate; to restrict payment of Medicare strictly to Medicare – and to not allow patients to contract with doctors separate; to pay the same Medicare rates in locations without regional variations and to homogenous and standardize care regardless of poverty levels and hospital and practice expenses; to dictate the contents and comprehensiveness of health plans and to impose the same premiums on all individuals regardless of age, sec, and health status; to tax “Cadillac” health plans, medical device companies, the pharmaceutical industry, hospitals, and those providing or paying for cosmetic procedures to pay for increased coverage.


• the ability of those health care entities who are taxed to pass on their increased expenses to consumers and how average Americans will tolerate increased costs and decreased access when they were promised otherwise.

• the diversified United States culture, its status as the greatest immigration destination in the world, and its ability to handle and pay for this diversity.


• “health care” versus “medical care” and the expenses therein; only about 15% of a nation’s “health” depends on its medical system, the remainder rests on socioeconomic conditions, personal behaviors leading to obesity and other health threatening disorders, and social cohesion and expectations.

• our legal and malpractice system, which increases health costs by roughly 10% through the practice of defensive medicine and excessive malpractice premiums and drives many specialists to other states or to early retirement and non-clinical careers.


• the doctor shortage and the mal-distribution of primary care doctors and specialists and the looming political health care crisis as aging boomers and greater numbers of the now covered uninsured seek access to doctors.

• how to explain to Americans that taxes and expenses will go up in 2010 but benefits will not kick in until 2014.


• The wishes and ambitions of politicians – 60% of whom say overall reform is necessary – and the will of the people - only 40% of whom approve of current health reform bills, 17% of whom say health reform is not their first priority, and most of whom who regard the economy, unemployment, and the national debts as greater threats to America.

• who should make clinical decisions - government, caregivers, or the people themselves – the latter through health savings accounts and high deductible plans that encourage them to spend their own money wisely, to insist on cost transparency. and freedom to chose their own doctors and hospitals.