Health care for all: one physician's Rx

By Ronald David Weiss

As America’s health care crisis deepens, the chorus demanding a universal solution grows louder. Health care is shaping up as one of the top issues in the 2008 presidential race. Like it or not, universal health care may be the only realistic path to pursue.

The major challenge is paying for it. Here is one doctor’s prescription for how to do it.

• Make it America’s business to cut costs. We have a form of federally sponsored universal health care that functions well for seniors and the disabled: Medicare. The average health insurance company is estimated to spend 15 cents to 30 cents of every premium dollar on administrative overhead, compared with Medicare’s 2 cents to 5 cents.

Rx: Take the billions of dollars that employers and individuals pour into commercial health care plans, turn them over to the federal government and allow Medicare to assume everyone’s care.

• Ensure access to lifesaving tools. Ultimately, the upward spiral of health insurance premiums is fueled by rapidly rising drug costs. If the development, manufacturing and sale of drugs are not federally controlled, the prices companies demand for essential drugs will financially swamp any system designed to contain costs.

Rx: The federal government should assume the responsibility of research and development for new drugs and then license the drug companies to manufacture the medicines and sell them at negotiated prices.

• Junk food is killing us. Many doctors would say that obesity, diabetes, hypertension and high cholesterol caused by the overconsumption of junk foods suck up many more health care dollars than even smoking-related diseases.

Rx: Place a significant tax on junk foods. If consumption of these foods continues unabated, the tax will become a rich source of revenue for health care expenditures. If consumption drops considerably, expensive diseases such as diabetes will be prevented. We could also pay people to normalize and maintain their weight by giving them tax credits or reductions in Medicare health plan premiums.

• “An ounce of prevention.” For every dollar spent on preventive health care measures, at least two dollars in health care expenditures are saved. As Medicare patients age, the risk of disease increases. Currently, a Medicare patient is entitled to only one preventive wellness exam, at age 65.

Rx: Why not allow Medicare patients a wellness exam every year? This would allow doctors to prevent illness and slow the progression of the diseases of aging.

• The baby boomer burden. Within the next 20 years, the aging baby boom generation will cause the frail and elderly Medicare population to double. Astonishingly, it is estimated that 25 percent to 30 percent of Medicare’s $327 billion annual budget is spent on care during the last year of life, and of all the money spent in the last year of a Medicare patient’s life, 40 percent of it is spent in the last 30 days.

Rx: Medicare should implement a program to help all beneficiaries develop living wills that would clearly direct care at the end of life and save money. Families and their physicians should also be Educated about the humane and cost-effective Medicare hospice program so that it is used more widely.

• Medical malpractice reform. The growing threat of malpractice litigation in this country drives up health care costs by forcing doctors to practice defensive medicine, ordering extraneous and expensive tests. Moreover, doctors are demoralized by skyrocketing malpractice insurance premiums. Many states are losing “high-risk” obstetrics, neurosurgical and orthopedic specialists who move to states not in crisis or quit medicine. Surveys indicate that the morale of the medical profession is at an all-time low.

Rx: Malpractice cases should be removed from the civil court system and be tried in a malpractice court where a panel of specially trained judges and medical experts would decide whether malpractice was committed. With such an equitable system, it would not be necessary to legislate caps on awards for pain and suffering.

• Take care of the patient by taking care of the doctor. A generation ago, doctors were paid handsomely for their services, but in recent years, Medicare and insurers’ payments to doctors have stagnated and decreased, while the overhead costs for medical practice have risen inexorably. Ironically, as doctors’ reimbursements have decreased, total health care spending has drastically increased.

Rx: Medicare needs to fix the way it pays doctors and establish a fair fee schedule that takes into account the rising costs of practice and of living.

Ultimately, with innovative ideas and bipartisan support, we can bring about universal health care and realize the promise of our great nation – one that guarantees to all people the essentials of living, including freedom from fear of disease.

Dr. Ronald David Weiss is a board-certified internist and emergency room doctor who runs an urgent and primary care center in West New York, N.J. His e-mail is
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