At the top of the list would be to provide legislation to allow insurance companies to provide insurance coverage across state lines. This would surely increase competition and lower costs. I do not know if this is federal or state control. It is my understanding that in several states, there is only one insurance company providing health insurance coverage. With no competition, there is no incentive to lower costs.
Somewhere, somehow, some regulatory agency should be able to make medicines available at a lower cost. Drugs from Canada cost about half the cost in the U.S. I understand the need for research and development, but when my pharmacist advises me to buy stock in his company because "we are making money hand over fist," I wonder how much this contributes to the cost of medicine. Perhaps drug companies could provide fewer lunches and dinners for physicians and have fewer TV advertisements. Drug company-sponsored CME's (continuing medication education) for physicians, although denied by pharmacies, really amounts to infomercials and directly fund for-profit medical education companies to organize these functions. Eliminate these activities. I am sure these are small items that affect the bottom line minimally, but we have to start somewhere. Conclusion: Some people have to choose between buying medicines and eating.
In a September address, President Obama acknowledged that "excessive litigation may be contributing to rising costs." The present 1,990-page House bill provides "incentive payments to each state that develops an alternative medical liability law that encourages fair resolution of disputes and maintains access to affordable liability insurance." However, the state only qualifies if its new law does not limit attorney fees or impose caps on damages. Huge contingency fees and damage awards are the mother's milk of frivolous lawsuits. Texas imposed malpractice caps and saw a huge drop in malpractice premiums and a flood of new physicians. I have heard that the Senate bill avoids tort reform entirely. A think tank recently estimated that last year, $240 billion in health care expenditures were the result of physicians ordering unnecessary procedures to protect against the risk of lawsuits.
Obama fairly chortled when he announced that "we have the AMA on board." The AMA has endorsed Obamacare. No surprise there. The AMA is largely composed of academics and salaried hospital-based physicians. The opinion of this irrelevant body does not begin to reflect the opinion of those physicians who go to the office every day and practice medicine at the patient level. To paraphrase an old saying: Those who can, practice; those who can't, attend AMA conventions. After I heard the AMA position, I contacted their office via a comment line. I asked what percentage of U.S. physicians belongs to the AMA - 20 percent. This came directly from the AMA office.
The American Nurses Association (ANA) had a photo op with Obama, all dressed in white uniforms and supporting the new legislation. So while I was at it, I called the ANA. Of 2 million-plus nurses in the U.S., 7 percent belong to the ANA.
The AMA "on board" and the ANA in white are misleading and leave an erroneous impression that they represent all physicians and all nurses.
We do need health care reform, but not this sweeping proposal. The packed town hall meetings and the TEA parties should get some attention of our legislators. A 220-215 vote should not be considered a mandate. Maybe we should try some of these lesser things.
One last thought: There will be an annual fine for those of us who decide not to buy health insurance.
Ed Hawbaker, M.D.
Rewarding bad behavior through scholarships
To the editor:
Growing up, I was always punished for my bad behavior. My parents taught me that if I did something bad, I was not going to be rewarded. Now, at the age of 20, I have learned that my parents were wrong. Bad behavior does indeed get rewarded.