08/31/2009 05:12 am ET | Updated May 25, 2011

Dialogue on Healthcare: Your Comments, My Responses and Apologies

People are responding to these healthcare blogs with comments and rebuttal. Thank you. Dialogue is the first step to a cure for healthcare: not among self-styled experts and power brokers but between us - the people in the trenches - patients and providers alike. We are simple and have only one agenda: we want a system that works. In order to facilitate our continued communication, I have provided your Comments (below) and then responded.


"Author is glib. Author used scare tactics."

Before dealing with substance, there were two charges laid at my doorstep that need resolution. To the accusation of being glib, I plead "possibly guilty." I see my job as getting at the essence of very complex issues and fomenting discussion. If I oversimplify, I apologize. There is no doubt that the issues in healthcare are confusing, multi-layered and require in depth consideration rather than glibness.

A "scare tactic" is used for the purpose of scaring. The substance and accuracy is irrelevant. If you have chest pain and your doctor says: Changing your diet won't open your arteries; you need heart surgery, is she using scare tactics? When I write that ObamaCare won't work and that we need radical change, I do so for the purpose of communicating important information, not scaring you. If it is scary, the truth often is.

"What the author [me] wants is impossible. Take what we can get."
The attitude of compromise; the art of the possible (Bismarck's definition of politics); the seduction of incrementalism - they are what has kept us from curing healthcare. "Taking what we can get" is code for quick, easy answers; an excuse to treat symptoms not causes. "Taking what we can get" may (temporarily) make the patient feel better but never makes the patient be better.

I am neither glib nor crazy when I assert the following.
1) Curing healthcare IS possible.
2) Doing it slowly in stages will fail. For details, see the forthcoming book "Rx for Healthcare."

"Single payer is the answer."
Single payer is like the Christmas spirit. It makes everyone feel good but means very different things to different people. It presumes that a single payer - the government -will save money by being much more efficient and less administratively wasteful than a cacophony of insurers. Is there any evidence or precedent that government has ever simplified anything, ever voluntarily limited its own power, or has ever reduced its own bureaucracy?

More fundamentally, simple sound bytes like single payer imply that a cutesy phrase can encapsulate all that wrong with healthcare and what to about it. Does "$5Revolution" call to mind all ten reasons for high healthcare costs?

"We can find the money."
"If we can find trillions for stimulus and two wars, we can find the money for healthcare." There are two responses to this Commenter. First, we are not "finding" the money: we are printing it and thus mortgaging our children's future. Sending our deficit into the stratosphere is not a cure for anything.

On the flip side, let me quote a friend and medical colleague. Testifying before our State legislature on healthcare, my heretical friend said, "We do not need more money! Healthcare has enough. It is just distributed improperly." As the British say, spot on. Imagine how much health care we could provide if the $500-700 billion that is wasted each year were to go to the patients.

"Systems from other countries can work here.
Several commenters recommended the health care systems used by other countries as answers for the USA. There is much we can learn from the experience of other countries such as the EU, Canada, Japan, and Taiwan. However, they too have major problems and have employed solutions that would be categorically unacceptable here. We must create our own and not expect nirvana by simply transplanting someone else's system.

"I need three things right now!"
1) "Covering the uninsured." Universal health care is what we seek. Universal health insurance coverage is not the same at all. Oh...should universal health coverage include illegal aliens? In most universal health care countries the answer is no. Please do not simply ignore or avoid this sensitive question as Washington has conveniently done.
2) "Eliminate pre-existing conditions." Sure, let's do it. Nonetheless, the insurance companies will still find or create ways to deny care because with our present system, that is how they make money. We have to change the system, not rearrange deckchairs on the Titanic.
3) "Keep insurance if I change or lose my job." Enacted in 1996, HIPAA was intended to fix the problem of insurance portability. That was what the "P" stood for. Thirteen years later, the problem remains unfixed. Oops.

"Competition is the key."
In the marketplace of commerce and business, competition is for dollars. Sellers offer better prices, higher quality, or easier service in order to entice buyers. The ultimate goal is money. All incentives are focused on that prize, and efficiency is highly valued.

For both patients and providers, the ultimate prize in healthcare is not having the most dollars. It is the best and longest health. Having good health helps both the individual and our nation. If competition would focus on who gives the most health, not health insurance, health care, the consumer and the country. As long as competition is based on spending the least in the short term, we all lose.

"ObamaCare is a dog, but it's Congress' fault, not Obama's."
Watch what is happening inside the Washington political mincing machine. We started with the President very rightly raising the healthcare issue from a dirty secret hiding in a corner to national hot topic status. He then immediately limited the dialogue to only one element: financing. Congress took a problem -- healthcare -- that crosses all political lines, and turned it into a bone fought over by wild dogs. All workable ideas have been eviscerated.

Mark these words. I can absolutely guarantee three results from whatever Congress passes and you know it will pass something. 1) The Administration will hail the Act as a great victory...for us, but 2) The Act will neither improve the health of Americans nor fix healthcare. 3) The Act will dramatically increase the size and reach of bureaucracy and will deepen the deficit hole we are already in. That is not a scare tactic. Just wait and observe especially three years from now when the problems of healthcare are even worse than they are now.

My apologies to Congressman Vic Snyder
In my last blogpost (7/28/09), I quoted Arkansas Congressman Vic Snyder from a news release encouraging support of ObamaCare. I assumed that he wrote it as the release specifically mentioned him by name and referred to his District. His office corrected me. He neither wrote nor had any knowledge of the release. I apologize to him and want you to know exactly what happened.

The House Committee on Energy and Commerce published news releases describing the advantages that ObamaCare would -- according to them -- provide in various Districts. The Representatives of these Districts were neither party to nor aware of these releases. Because the Congressperson of each District was named in each release, most people would assume, as did I, that the named Congressperson at least approved it. Not so. These news releases give the appearance that all Congresspersons support ObamaCare, whether they do or not. Sneaky devils in our Congress.

"Anything is better than what we have now."
I do not support the status quo. We need radical change. The following is not a defense of what we have now. It is a counter-argument to "anything is better." Do you want?
• not having better treatments for cancer, heart disease and HIV because we destroyed our pharmaceutical industry as they did in Italy?
• spending 43% of our annual budget on healthcare, like the Canadian Province of Quebec?
• being denied dialysis because of your age, as in Great Britain and Germany?
• dying from breast cancer because your government refused to approve a new [expensive] drug that works, as was reported in Australia?
Need I go on? Other countries are struggling with healthcare system problems as big as ours. I do not suggest that healthcare is insoluble. Au contraire. Healthcare is fixable but fixing needs all of us in the decision-making process. Fixing requires learning from others' mistakes as well as our own. Fixing demands rejection of all sacred cows.

A true fix requires our creating a new, uniquely American healthcare system.