So what's my recommendation? Part 2

It is clear something needs to be done about health care in this country. It is without a doubt a major problem, and calling it a "crisis" is not too far from the truth. That does not mean, however, we must rush to just ANY solution rather than wait and look for a good solution. Health care has been in crisis since the early nineties and arguably since before the Great Depression. Medicare was first proposed following the Great Depression in 1945, by Harry Truman. Twenty years of debate later, Medicare was started in 1965. Medicare is projected to go bankrupt in 2019. I personally do not have a problem with a government program made to act as a safety net for those who need it. My concern grows when the government becomes such a large entity that the private sector cannot compete. We have already seen this government program called Medicare fail, and I believe it is a bigger mistake to establish a much larger government program in its place.

Ironically, Democrats assert that private programs exist outside the government and in fact thrive. In a rather poor argument for his health care plan, Obama himself stated that UPS and Fedex do "just fine" and it's the "postal service that has all the problems." Why then would we need a larger postal service with all the government inefficiency and beauracracy? Why not improve the existing postal service (or allow UPS and Fedex to thrive and pick up the slack)? Likewise, Medicare is failing, and I will soon give some good reasons why it is. Why not eliminate those problems rather than making a larger goliath that is more of a fumbling baffoon than the first?

Capping malpractice lawsuits/Tort Reform has long been the most needed change in health reform. Currently, only certain states have placed restrictions on how much money a person can sue for. This is problematic because there are no laws against suing in general, and when there are no limits, there's really no harm in filing a lawsuit. Additionally, many lawyers will take the case based upon a potential settlement without any cost up front. This creates a major problem because there is substantial financial incentive without deterrent or regulation. In fact, many cases are settled outside of court, despite no wrong doing from the physician, just because a trial costs much more money. Malpractice insurance then increases substantially, and physicians begin practicing "defensive medicine" where they order more tests just to protect themselves from a potential lawsuit. This also drives physicians away from areas needing physicians because it costs too much to practice in that area due to malpractice insurance, or the risk is too high because one lawsuit can devastate an entire career. Tort reform would therefore:

1)reduce paperwork
2)reduce unnecessary tests
3)lower malpractice insurance
4)increases access by encouraging providers to serve all geographic locations


Another way to decrease the cost of healthcare is by restricting pharmaceutical advertisements. We have all seen those drug commercials on the televsion set, but we never know what they're for. All we know is, a middle aged man is throwing a football through a tire and then going away with some woman we presume is his wife. Sounds sort of benign, but what does that commercial do? From the very beginning, people have been skeptical of doctors receiving incentives from the pharmaceutical industry, and for good reason! All the studies demonstrate drug representative dinners hosted by pharmaceutical companies does influence prescribing practices. So the lawyers caught on and introduced legislation to prohibit pharmaceutical companies from "buying off doctors." No problem there; I made it my own decision not to be influenced by drug companies long before that law came into effect. Many of my colleagues did the same. The reasoning is this: having a really nice dinner for free, or whatever else they give you, really isn't. Nothing is free. Universal health care is NOT free. A dinner by the drug companies is NOT free. The truth is, less than a quarter of the total budget of pharmaceutical companies actually goes to research, development, and production. More than two-thirds goes to marketing and advertising. The drug companies spend millions of dollars on these 2 minute commercials because physicians have chosen not to allow them to influence our prescribing habits. They now have the patients ask us if the drug "is right for you." Which amounts to the same thing. I was opposed to drug rep dinners because the dinner wasn't on the drug company, it was on my patients. The cost of advertising and marketing (or soliciting doctors) gets passed directly on to the consumer. The pharmaceutical company is in it for the money. You can ask a few of my friends who have worked at drug company parties how much they're bringing in. The millions of dollars in a commercial is passed directly onto the patient. That's why brand name drugs cost an arm and a leg! Think about it, when was the last time you saw a commercial for penicillin?

We have already heard of the government's plan to impose a tax on "junk food." Rather than having the government regulate everyone, why don't we regulate those who are already depending on the government? Advanced disease conditions are already associated with lower socioeconomic status. Why don't we prevent part of this by regulating use of food stamps for "junk food?" A person could argue we tax cigarettes because they are unhealthy, why should junk food be any different? Cigarette smoke is correlated with disease, but it affects everyone and is therefore a greater public health issue. The risks of second hand smoke are well documented, and if it causes an increase in our health care costs, by all means it should be taxed. Eating a hamburger does not harm the person who is in the room with you while you eat it. If the lower socioeconomic class creates a greater burden on the system by depending on the system for food stamps, and then also by having poor health, why not reduce the strain on the system by promoting healthy food consumption? The government already regulates food stamps so that a person cannot by drugs or alcohol, it would be fairly simple to extend it to junk food.

Another option would be to allowing insurance companies to cross state lines. This would encourage competitive rates throughout the nation rather than in states alone because the insurance companies could negotiate deals with hospitals and physician groups are a broader scale. It would also allow greater access to care and reduce costs in other ways as patients would not have to worry about being "out of network." Obama has stated he believes the bad guys are, in addition to doctors, insurance companies. Similarly to pharmaceutical companies, I don't believe insurance companies themselves are the problem. I believe the problem is allowing various sectors of the health care industry to go relatively unchecked. By placing regulations on the insurance companies, we can avoid the problems, and still reap the benefits. Just like banks are not the problem, unchecked banks who give bad loans to everyone are the problem.

One important issue that hasn't gotten any media attention, but deserves just as much attention as Obama's healthcare reform plans, is illegal immigration. Please note the emphasis is on "illegal immigration." Obama's plans for next year have been stated to include legal immigration, but the discussion on illegal immigration has been surprisingly absent for the last decade.

The most illustrative perspective of this problem is from the perspective of what is happening in California. Please note that I did two years of family medicine residency in Santa Ana, Southern California. Emergency rooms around the entire southland have shut down permanently due to the strain on the hospital - much coming from undocumented immigrants who cannot or will not pay for care. Typically, emergency rooms aren't a very lucrative investment for hospitals unless they are able to admit patients to the inpatient service. Unfortunately, hundreds of thousands of emergency room visits are for uninsured patients, and additionally uninsured undocumented patients. ER's are not permitted by law to turn anyone away, consequently they absorb the brunt of uninsured undocumented patients.

With all of the manpower involved in the ER, this can be a very costly endeavour if the patients cannot pay, will not pay, and there is absolutely no recourse to make anyone else pay. They get all the best resources the ER has to offer, and they are discharged. That's the best case scenario. What happens when the patient is really sick and needs additional care? The hospital cannot turn the patient away from the ER in the first place, and therefore also cannot turn them away if they're really sick and need to be admitted. The hospital then admits them, and they are treated on the inpatient service even though they still can't pay.

The consequence is we all pay. All of us tax paying Americans. A couple cases here and there aren't a big deal, but when hundreds of thousands of people use the ER to see any doctor because it's free health care for them, it becomes an enormous problem. I see people for colds every day, just because they can't or won't pay for a clinic visit. It becomes the most expensive clinic visit ever, but at the American tax payers' expense.

Additionally, why not go to the hospital for an expert opinion for everything if it's free? I have seen a child run into the emergency department and jump on my lap so I can examine his scraped knee. If a child runs through your office and jumps into your lap, chances are there's nothing wrong. It was even worse because mom didn't even clean it or look at it. She didn't have any reason to do anything - we would do it for her for free.

Additionally, illegal immigrants also do not have the same vaccination policies and health care from their native countries. They may expose our current population to communicable diseases which otherwise may be eliminated from our society. This can be seen in the rise of pertussis, tuberculosis, measles, etc.

There is also the phenomenon of "anchor babies." The law is interpreted as anyone who is born in America is now an American citizen. Illegal immigrants count on the sympathy of Americans to keep them in the country because if their baby is born in America, we wouldn't separate them to send their parents back to their country of origin. This places tremendous incentive for them to utilize the health care system. If they wait until they're going to deliver, run into the hospital for free health care, their baby and themselves are taken care of, the baby is documented as a citizen, and they have just punched their ticket to stay in America- all on the tab of the American tax payer. What makes it worse, is these babies have little or no prenatal care. The physicians have no idea what they're walking into, and these babies can potentially be very sick.

Even more difficult than seeing an illegal immigrant receive care for free, is seeing a tax paying American citizen get the same exact care and having their savings wiped out, their credit destroyed, and their wages garnished because they have a social security number. Why should people who haven't contributed any taxes to our system be bailed out for free, when someone who has contributed their entire life gets everything taken away from them? It should not be a punishment to be a tax paying American. What is important to note is that equality does not mean equivalence. I believe people have the same inherent worth, but that doesn't mean they should get the same treatment. We love our children the equally, but we wouldn't allow our 5 year old to drive our 16 year old's car. Likewise illegal immigrants are equally as valuable as citizens, but that doesn't mean illegal immigrants should recieve benefits at the expense of tax paying citizens.

I do believe emergency rooms should always be available for everyone, no matter what their citizenship, in the event of an emergency. However, I believe if they are not an American citizen, after their condition is stabilized, they should be deported to their country of origen. This alone would decrease the burden on our health care system by hundreds of millions of dollars.

Passing legislation to close our borders and elimate "anchor babies" would therefore:
1)ease burden on emergency rooms
2)eliminate wasteful spending
3)focus health care attention on tax paying Americans
4)decrease potential risk of some diseases

My final point I believe everyone would agree with. It is important to legislate against denying care based upon preexisting conditions. Obama stressed this as an important point, and I agree completely. I don't, however, believe we must implement universal health care reform to do so. Simply making a bill to stop health care insurances from discriminating against people with preexisting conditions would do the trick just fine. By doing so, it would allow equal access whether or not a person is already sick, it would increase preventative care because their condition can be treated before it gets worse, and it would encourage patients to obtain health insurance for other medical needs. A simple solution to cover the cost, rather than overhauling the current health care system, may be to increase copays.

These points I've presented are not new to health care reform, but have been argued for years without any response from the politicians. Rather than creating a brand new health care system, why not implement these changes to improve the current system? As I've said earlier, a health care "crisis" does not mean we opt for the first suggestion that comes along, but we instead carefully plan out a health care system which would be maximally beneficial and reasonable for everyone. These changes are a good place to start while we're working those details out.