Doctor: 'Twin tsunamis' push up care costs


Few topics on the 2008 campaign trail are hotter than health care.

When it comes to covering the nation’s 47 million uninsured citizens, presidential candidates’ prescriptions have ranged from creating a single-payer federal system to reducing regulations on private insurance.

But real solutions will fall in between those two poles, a prominent doctor told a local business group Thursday.

Providing health insurance for the country’s uninsured and reining in high costs for all Americans will require government intervention, a stronger private health sector and a dose of personal responsibility, Dr. William Plested III, immediate past president of the American Medical Association, said at a luncheon at the Four Seasons for more than 200 members of the Las Vegas Chamber of Commerce.

Fixing holes in the nation’s health care net will also require acknowledging uncomfortable truths about the practicality of providing equal levels of care to all, he added.

Plested began by discussing the “twin tsunamis of technology and demography” that are pushing up health care costs in the United States. Pricey health care equipment and treatments, combined with longer life spans, mean bigger costs to Medicare and private insurance. Rather than insurance coverage or access to care, those rising expenses are the country’s true health care dilemma, Plested said.

“There is a crisis, but it’s a crisis of who’s going to pay,” he said. “Everyone says the same thing: ‘You will.’ ”

The private insurance sector and federal health care each have issues, Plested noted. Private insurance isn’t always portable from job to job, and today’s insurers are conglomerates that “behave like unfettered monopolies.” But he called Medicare a “Ponzi scheme” that is “bankrupt and unsustainable,” with a $34 trillion liability for future coverage.

The answer, Plested said, is to incorporate the better elements of both in any reform plan.

Consumers should individually own their insurance policies, because people know better than governments and employers what coverage they need. Insurance should also follow a consumer who loses his job, changes companies or goes into business for himself. Federal policies can help through tax credits, benefits and vouchers for insurance coverage. And covering the country’s uninsured is “clearly the place for government” to help, he said.

Plested said addressing the profit-driven motives of private insurers should also figure into repairing the system. Insurance companies classify care given to patients as “medical losses” — unacceptable terminology for life-improving and life-saving treatments, he said.

“We have someone standing between ourselves and our physicians whose only interest is in their shareholders,” Plested said.

Health care reform should also include paring state coverage mandates on insurers, expanding insurance-purchasing pools for consumers and holding down malpractice-liability costs. Plested advocated a nationwide insurance market that would allow consumers to choose from competing plans sold across state lines. He urged attendees at the luncheon to look on the Internet for federal employee health benefit plans, which provide “the widest array of medical insurance available at the lowest price,” and exhorted them to ask why consumers shouldn’t enjoy the same buying power federal workers have.

Plested also said the nation must conduct a “difficult discussion” about health care equality — the idea that all consumers should have the same level of care.

“There’s no way (the government) can afford everything for everyone,” he said. “We can’t give it all to everyone for free. That just doesn’t exist.”

Efforts to equalize care could cause fresh problems.

Wage and price controls on the medical industry would drive up long-term prices as doctors and treatments grew scarce, and rationing has led to denial of treatment in countries with government-run systems, he said. In Canada, for example, the government limits the number of hours doctors can practice, and budgetary constraints mean many hospitals close in November and December after they run out of money. Plested pointed to a 2005 Canadian Supreme Court decision that struck down a ban on private health care in Quebec; the court’s decision acknowledged that the country’s government-run health system was “causing the deaths of citizens,” Plested said.

Nor did Plested let consumers themselves off the hook.

An “unconscionable part” of health spending in the United States goes toward treating preventive ailments that result from poor lifestyle choices, such as smoking and skipping exercise, he said. That means Americans could reduce the nation’s health costs simply through smarter living.

Plested said mending the U.S. health system’s weaker points will call for “honesty about the problem” and clarity on what a plan will include. Americans should share their ideas with each other and with people running for office.

“If we let politicians know what we want, they’ll do it,” Plested said. “But if we don’t know what we want, they won’t do it. We’ve got to have a national discussion and decide what we want to do and what we don’t want to do. We don’t want someone to decide based on a soundbite what our policy will be.”

Contact reporter Jennifer Robison at or (702) 380-4512.

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