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Real Health Care Reform -- If You Want It

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The push to bring American health care into the 21st Century is in full swing, but whether the debate is in full cry is another matter. That matter is pretty much all being left to the experts, while the rest of us wait to see what we'll get.

That's disappointing, but predictable: Aside from everything else -- the highly emotional issue of rationing, for instance -- the debate is deeply technical and statistics-laden; even the most curious civilian soon finds himself swooning over the arguments. Professionals, meanwhile, are likely to be blowing steam out their ears over one proposal or another.

But one things is perfectly clear; by any measure, the cost of health care will bankrupt this country by mid-century if we don't do something now. Looked at it this way, stalling or trying to derail the current push is deeply unpatriotic.

But dealing rationally with the issue seems to be out of the question; all we seem to hear about is the evils of socialized medicine -- read, the road to Communism -- and how any system of national health care will mean denying life-saving care to the deserving.

Try telling that to the widow of my best friend, who had first-class health insurance and excellent doctors; he died in one of New York's best hospitals after being denied a heart transplant, because there are only so many hearts available, and he was a poor candidate.

The truth is, we ration health care in this country every day. The decision about my friend was perfectly rational, and in the condition his problem had left him, he really didn't want to keep living. But that doesn't mean the doctors made no decision.

Meanwhile Congress is dealing with one of the least important of this clutch of issues, and ignoring the real dragon in the room; how to pay for health care means nothing if the cost of care keeps growing at anything near its current rate.

That's probably because nobody likes insurance salesmen, but we all more or less worship doctors. But it leaves out the fact that American health care is a profit-driven business, that maintaining profit margins is the whole point of business, and that America's health care systems is a messy collection of suppliers, each preoccupied with the care and feeding of their profits.

The obvious solution is to create a health care system that's like an integrated manufacturing company, in which providers of everything from aspirin to brain surgery deliver their goods at cost; it's how both Andrew Carnegie and Henry Ford drove their competitors out of business. No profit margin for suppliers means lower production costs for sellers.

Am I talking about a national health care system -- socialized medicine? No.

What I'm talking about is encouraging more integrated medical delivery systems like Kaiser Permanente and the Mayo Clinic, which operate very profitably on an integrated model, and deliver excellent care at much lower costs than their competitors. Nothing un-American about competition, is there?

Kaiser Permanente, which combines for-profit medical operations with a not-for-profit insurance division, is even more profitable than many private health care delivery systems; last year, it delivered $34.4 billion in annual operating revenues and $1.3 billion in net income, while in the same period Hospital Corp. of America, the private industry's largest firm, posted operating revenues of $28.37 billion, against $673 million in net income. Kaiser has been in business since 1945.

Clearly, it's got a practical business model, or it would have failed before now. Based on the facts, it's superior. And adopting it industry-wide would obviously encourage competition, and drive down overall health care costs, nationwide. Mr. Market would smile upon it. And it would do the same thing the Administration's public financing option would do -- encourage good, old-fashioned American competition.

Yet nothing is heard about the idea so far, probably because those who'd rather leave things as they are, are hoping to smother reform in its cradle. They're doing this, among other things, by waving all sorts of dishonest slogans in the air to confuse us -- many of which don't even have a basis in the facts, like the so-called "rationing issue".

The fact is that the arguments being made against taking real, effective action to deal with our health care problem are dishonest, at best, and designed to bully us into dropping the whole matter. Otherwise, the people behind them would have to think of somebody besides themselves. It makes you wonder if they really love their country, or just see it as a flag of convenience.

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