Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare
Posted on August 11, 2009
Filed Under Uncategorized |
Critics of the Obama health (insurance) reform plan have been formally served notice that they are under observation, and should they be caught making obvious errors in describing the proposed plan - or worse, they are detected emanating piscatorial odors - they are likely to be 
reported directly to certain concerned individuals at the White House (Hi, Linda!), who will take steps to correct such wrong-thinking. So, as he embarks on this week’s edition of Grand Rounds, DrRich would like to welcome any visitors who are here on behalf of such important surveillance efforts, and hasten to tell you that DrRich is on your side. Indeed, this version of Grand Rounds is dedicated to exploring the many ways in which the proposed health (insurance) reform will succeed in all its goals, and most especially in achieving cost containment.
In view of the length this edition of Grand Rounds promises to take, and in recognition of the extraordinary number of websites that you servants of truth need to peruse in conducting your vital mission, DrRich hereby asserts that you will find no malefactors here - oh, no! - and urges that you may safely move on (as it were) to those other, possibly less compliant, websites and blogs. (And from what DrRich has seen, you should not ignore Twitter, either.) Godspeed and good hunting to you!
So.
On The Nature of the Debate
August was to have been the month that the American people were to participate in town hall meetings, in which they were to: a) listen respectfully as their legislators explained to them their plans for healthcare reform, then b) ask respectful questions of their elected leaders about what they had just been told, and c) listen respectfully to the answers and clarifications which then would be provided. The process has become more raucus than that. And as one might expect, some bloggers have decided to comment.
On the EM-Blog, Neal Little asks: When do we get to really debate healthcare? Thousands of pages of reforms are now being considered, Dr. Little asserts, without our having discussed and settled on numerous important issues - details, as it were. He rhetorically wonders where the the obviously necessary discussions on these issues have disappeared to. While Dr. Little makes an excellent point here, DrRich must remind him that much of this discussion was accomplished this past winter. Remember? Mr. Daschle (still thinking he was going to be a guru or czar or minister of healthcare) urged us regular folks to host block parties all across the land to discuss these very issues, and get back to him with our conclusions by December 30. And while Mr. Daschle didn’t get any of those important jobs after all, he did indeed gather for the new administration all the answers he sought from “the people.” For Dr. Little’s benefit, what we regular folks reported to Mr. Daschle was was: we want affordable, efficient, complete, cradle-to-grave healthcare for all, without tax increases, and certainly with no restrictions on our prerogatives as patients. And indeed, that very thing, our legislators assure us (whenever they can get a word in edgewise over the disruptive, organized right-wing mobs that keep showing up at the town hall meetings) is exactly what they are planning to deliver. Of course, as Dr. Little correctly suggests, we are still quibbling over some of the details.
In stark counterpoint to Dr. Little’s plea for a more robust debate on healthcare is this post from Toni Brayer at EverythingHealth, who asks (and answers) the question, “Are Americans Stupid?” Dr. Brayer has lost patience with the town hall disruptors and their asinine questions (which, she points out, are too often of the non sequitur variety, and display a certain lack of sophistication). She commends to us the words of Mr. Bill Maher, who is more than satisfied to turn the reformation of our healthcare system over to our leaders, the “elite group of people who know what they’re talking about.” In other words, in contrast to Dr. Little, Dr. Brayer seems to consider the proper time for public debate (if, indeed, the public is ever really capable of fruitful discourse) to have ended.
To try to sort this all out, Evan Falchuk from See First suggests that proponents of currently proposed healthcare reform should not be so quick to dismiss the angry rabble. He points out that the most clear-cut and proven way to get the unwashed masses to go along with major changes in any policy is: clear, direct and honest communication. Rather than bashing the opponents, or dismissing them as too dim to matter, in other words, try telling them the truth in clear terms.
DrRich thinks Mr. Falchuk is on to something here. One reason President Obama had widespread early support early on for his healthcare reform plan was that he explained in clear terms what he wanted: affordable coverage for the 47 million uninsured Americans, without creating any overall increase in healthcare spending (and indeed, reducing overall costs through efficiencies and preventive medicine), and no tax increases on middle class Americans. If people believed this is what the pending bills would deliver, his plan would still enjoy great popularity. But the non-partisan CBO now tells us that the current proposals would leave something like 30 million still uninsured, would engender $1.5 trillion in additional spending over 10 years, and would certainly require tax increases for everyone. So: The clarity of Mr. Obama’s message is gone, and the people don’t know what to think. Some of the people have become disruptive, ’tis true. But that’s what happens when the rabble believe they are being snowed by their elected officials. DrRich’s recommendation to legislators echos that of Evan Falchuk: Be clear. Tell the truth. And if that means you have to read the bill yourself, DrRich is very sorry about that (having tried to read parts of it himself), but you’ve got to do what you’ve got to do.
Cost Containment in Healthcare
President Obama has continually emphasized that the primary requirement for any healthcare reform is that it must control costs. As noted above, however, the fact that the CBO says current reform plans will do the opposite has created an uproar among the populace. The need to control costs (acknowledged by everybody), combined with the fact that current plans project major cost increases, leaves the people (and the medical blogosphere) in a position where we must speculate on just where those cost savings will come from. And if there’s one thing those of us in the medical blogosphere are really good at, it’s speculating. (DrRich will simply point out that since the methods that will be used for cost containment are not being spelled out, they must necessarily be, well, covert. And therefore speculation is being explicitly invited by our leaders.)
We begin this topic with an important post by Sandy Szwarc at Junkfood Science. Sandy addresses the provision in House Bill 3200 that has perhaps raised the most widespread concern - the language that requires seniors to have periodic “end of life counseling.” Opponents say it’s a pathway to euthanasia, while proponents counter that it’s a completely benign provision that’s entirely to the benefit of seniors. Sandy begins her careful analysis with the actual language of the bill (which is so convoluted that one can almost forgive our legislators for not reading it, especially since it is apparent to anyone who has listened to them that most of them are not the brightest of bulbs), and then places that language in the context of the known objectives of those who wrote the bill. Her conclusions are sobering. Sandy does brilliantly with research and analysis what DrRich lamely tries to do with humor and sarcasm. Please read her post.
Henry Stern of InsureBlog thoughtfully considers some implications of the fact that current reform proposals apparently mandate coverage for abortions - and he manages to do so without making claims, on one side or the other, on the morality of abortion. There are indeed more implications to the abortion provision than DrRich had previously thought of. One thing does seem clear to DrRich, which is that the large majority of aborted Americans, had they been born, would have been pure consumers of society’s resources - healthcare, education, food, etc., - for a good 20 to 25 years before they began to contribute substantially to the GDP. So from a pure cost containment standpoint, the abortion provision looks like another winner.
Here’s a fantastic post from Kim at Emergiblog on the wonders we might achieve with healthcare reform - while saving money - if we were willing to look at a healthcare model that’s virtually right under our noses.
Speakling of animals, here’s an amazing post from Bonzi at All Things Amanzi. Now, DrRich has warned his readers time and time again about the 
hazards of obesity, but Bonzi describes a hazard that never occurred to DrRich: If you are fat very it’s hard to run away from an angry hippopotamus. While reluctant to support discrimination against the obese, Bonzi expresses the belief (after having to clean up the aftermath of this particular encounter) that obese individuals should be restricted from entering wildlife reserves, at least those wildlife reserves where one has a chance of being eaten. DrRich concurs, but not necessarily for the same reason that Bonzi gives. Bonzi, the compassionate physician, notes that the obese are simply too immobile to effectively escape rampaging hippopotomi, and for their own good should stick to viewing such beasts on the Discovery Channel. DrRich, on the other hand, hoping as always to advance methods of cost containment, finds a more compelling reason to deny obese individuals access to wildlife reserves: Not only are the grossly obese more likely to be caught by angry wild beasts, they are also more likely (as did Bonzi’s patient) to survive an attack (thanks to their thick layers of oleaginous armor), their subsequent survival thus requiring extensive and expensive medical care. (How many skinny people, after all, survive a hippopotamus attack?) DrRich has read several parts of HR 3200, but has not seen anything in any of them that would restrict obese citizens from frequenting wildlife reserves. This, DrRich asserts, is proof positive that the reform bills are not nearly as comprehensive as supporters would have us believe.
Still speaking of animals, Paul Zane Pilzer of the Clarifying Health blog suggests a fail-safe method for permanently fixing U.S. healthcare. Unfortunately, since it would require our legislators to behave as if they were “just folks” instead of the ruling pigs over at Animal Farm, they are likely to give his excellent suggestion a pass.
Dr. Shock gives us a remarkable demonstration of why a favorite tactic of covert rationing - strictly limiting the time doctors and patients can spend with each other - can be counterproductive not only to healthcare economics, but also to our humanity. Caution, though - his post contains a poem that even a concrete thinker like DrRich finds quite affecting.
The Cockroach Catcher discovers how withholding treatment for Obsessive-Compulsive Disorder can make us winners twice. First, we save money on all those expensive psych drugs; and second, we get lots and lots (and lots) of art!
The author of How To Cope With Pain shows us how new virtual reality tools can help people who are dealing with pain. DrRich is a technology 
maven himself, and finds the notion of using VR for pain management to be be quite interesting. Sadly, however, this will never fly under our newly reformed healthcare system. Simply take the prototypical example President Obama himself gave us for thinking about appropriate pain management, namely, the 100-year-old grandmother who needed a pacemaker, and in whom the president suggested that “a pain pill” would perhaps be a more judicious choice. The VR-approach to pain management is clearly not a good option here, that is, in an elderly person who (one has clearly decided) ought by rights to be in that famously expensive “last 6 months of life.” DrRich, for one, could never imagine his 100-year-old grandmother standing before a computer terminal, wearing a VR headset and madly working a joystick, even on her best days - let alone if she were really, really dizzy from the lack of a pacemaker. And second, considering that recommending a pain pill as a cure for for a slow heart rate is like recommending a bath as a cure for bankruptcy, relieving pain (which grandma did not have) cannot be the real reason for urging a pain pill here. Since using VR for pain relief does not provide the potential for the “more permanent” forms of pain relief that always attend the use of powerful narcotics, DrRich believes that the VR approach will entirely miss the real point. But, still, nice try.
Stacey Butterfield at The ACP Internist points out that preventive medicine may not be quite as cost effective as our political leaders insist. But, as Ms. Butterfield suggests, since the government is paying for it, at least it’s free.
Alvaro Fernandez at Sharpbrains posts about Preparing Society For a Cognitive Age. In the post, he considers what kind of, well, PR must be done to educate the public (to stimulate the funding of more research) about how we’re on the threshold of an era of “brain fitness,” mediated by computerized tools for assessing and improving peoples’ cognitive abilities. DrRich is (forgive him) of mixed mind about this. If cognitive training can delay or reduce the onset of Alzheimer’s disease, of course, he is all for it. But if all it does is to make the elderly less malleable and more incisive about important topics such as advanced directives, then DrRich is obligated to point out that improving cognition in old people might just cause us a lot of extra trouble.
In “Baby Steps,” Barbara Olson at Florence dot com notes that a new report from Hearst newspapers says 98,000 people per year are still dying as a result of medical errors. This number, virtually the same as the one reported about a decade ago by the Institute of Medicine, suggests we’ve made no progress during all that time. DrRich agrees with Barbara that this is a problem which, real soon now, ought to be taken up. This seems especially true since, as Barbara points out, we know what we need to do. But still, from a pure cost containment standpoint, before we decide to invest lots of money and effort in preventing these error-mediated deaths, we need a study to tell us whether the premature deaths of 98,000 Americans a year results in a net increase in expenditures - or net savings. (The victims of these medical errors were, after all, sick at the time, and had been consuming valuable healthcare resources.) For, if cost containment is priority one for our healthcare system, then the outcomes of individuals within the healthcare system can be no higher than priority two.
There are other tragedies that flow from medical errors. Dr. Ottematic tells us of the devastating suicide of a colleague in her family practice residency, a promising young doctor who apparently was despondent over believing she had committed a medical error. This event is especially sad since most medical errors are related to failures within a complex system, and most often, the doctor or nurse who may be the proximate cause are nearly as much a victim (of a broken system) as is the patient who is harmed.
Jolie Bookspan of the Fitness Fixer cites a new study showing that few if any of the myriad of medical treatments commonly used for treaing low back pain offer any substantial or long-lasting benefits. Dr. Bookspan points out that a more effective method of treating low back pain might be to retrain patients to move in healthier ways, to prevent continued re-damage. This seems like good advice to DrRich, whose unhealthy career choice (which involved wearing heavy lead shields while standing in place and bending at the waist for up to 12 hours at a time) led him to sample many of these ineffective (and expensive) treatment options himself. He was cured only when he chose to move in healthier ways - by changing careers.
DrRich is pleased to see that Dr. Charles is back after a long hiatus. At The Examining Room of Dr. Charles, he offers a clear analysis and interpretation of emerging evidence that exercise alone (even a lot of exercise) is not a very effective way to lose weight. Exercise doesn’t burn up as many calories as we all might hope, and in fact, a nice exercise session makes us think we can go ahead and have a couple of extra Twinkies. If we want to lose weight, it appears, we have to stop eating so darned much - exercise or not. With the information supplied by Dr. Charles, DrRich now feels confident offering the following investment advice: If healthcare reform passes, sell McDonalds.
So the problem of what we should eat certainly needs to be addressed as we reform our healthcare system. We need facts, not fads. Laurie Edwards of A Chronic Dose meditates on the impact of the new and growing popularity of the “gluten-free lifestyle” on those with celiac disease - people who have honest-to-goodness inability to tolerate any gluten in their diet whatsoever. She concludes that while there are some disadvantages, overall, widespread awareness of gluten-intolerance is a good thing for people with celiac disease. Of course, DrRich reminds his readers that soon, once it becomes the case that whatever you put in your mouth will be everybody’s business, the burden of making the difficult choices as to what to eat, thankfully, will be removed from us. Until that happy day arrives, having to deal with complicated considerations like the ones Laurie describes will remain our sad lot.
Louise at Colorado Health Insurance Insider tells us “What Women Want” in healthcare reform. What they want, among other things, is more flexibility in scheduling appointments. DrRich agrees with Louise that private insurers have not shown much more flexibility in “bending the rules” than we might expect from officious government bureaucrats. In fact, the only major advantage in dealing with private insurers instead of the government (if there are any advantages) is that the former cannot put you in jail for violating their arbitrary rules. Be that as it may, when it comes to containing costs within the healthcare system, we cannot expect flexibility on anyone’s part except the patients, who, after all, are mere supplicants, and consumers of valuable healthcare resources.
Catherine Busch at Child Psych points out a growing “access problem” that we don’t hear much about, and which pending reforms don’t appear to be addressing - the large number of kids with mental illness who cannot easily find qualified professionals to care for them. Qualified professionals, Dr. Busch points out, might be able to treat a lot of these children without resorting to expensive drugs.
The Clinical Cases and Images Blog submitted this post, which has to do with finding a spouse through social networking. DrRich almost did not accept it for Grand Rounds this week, because initially he could not see its relevance to things medical. But then he noticed that the data for this post comes from Drs. Christakis and Fowler, who have turned their remarkable “social networking” software into a virtual factory of peer-reviewed publications. One of their best-known publications is a remarkable piece, published a couple of years ago in the venerable New England Journal of Medicine, which “proved” that obesity is socially contagious. Have a look at their graphic here. This is an important piece of literature, especially in light of the righteous demonization of the obese that thankfully accompanies our current push to healthcare reform. Their research shows that even if you avoid the company of fat people yourself (in an attempt to remain acceptably svelte), fat people who are acquainted with your acquaintances may still have an impact on your BMI. And this leads us to only one possible conclusion: Either we must become complete hermits ourselves to avoid this hazard (an unreasonable proposition, to say the least), or we must insist on isolating and ostracizing all obese people from any social intercourse whatsoever, save with each other; concentrating them, say, in special camps. DrRich does not understand why our society has not yet heeded the clear implications of Christakis and Fowler’s research.
Nancy L. Brown at Healthline reminds teens that they, too, can sign up to be organ donors. DrRich can think of nothing sadder than a teen actually being in a condition to donate their surviving organs, and has nothing snide to say about this.
Reality Rounds reminds us that patients may often have had experiences in their past that put them in a far different place than we might think. It’s one of the reasons that when doctors and nurses simply follow the script as directed, we might not elicit the cost-reducing, guideline-specified response from the patient that the system demands.
On The Wards discusses a study that compares the relative efficiencies of electronically typed versus voice-dictated medical discharge summaries. Both work just fine, it turns out, but younger physicians (born and raised with AIM, text messages and Twitter) prefer typing. DrRich, however, hates to think of medical records stuffed with emoticons.
Walter Jessen at Highlight Health reports on the latest survey from Spectrum regarding what insured and uninsured Americans most value about their healthcare. Since what patients of any stripe value about healthcare matters little, the main benefit of such surveys is to inform our political leaders of what they should be telling us about healthcare reform, in order to render us more compliant, and less disruptive.
Finally, Sam Solomon at Canadian Medicine describes the latest antics of a former Canadian physician and current anti-vaccine activist named 
Ghislaine Lanctôt, who warns that the now-under-development H1N1 flu vaccine is but a ploy of the global elite. It will be loaded, she claims, with “an extremely vicious cocktail of avian, swine and human influenza viruses,” aimed at killing us off, and reducing the global population to 500 million. Impressed as he is by the sheer lunacy of such claims, DrRich is even more impressed by the fact that this physician lost her Canadian medical license in 1997 for espousing similar anti-vaccine opinions. Physician woo-masters in the U.S., who currently have free rein to advance their pet wacko theories, at least partly because we don’t yet have official government-approved theories, should see this as a cautionary tale. As much a proponent of free speech as DrRich is, he wishes there were a legal and non-violent way to keep Dr. Lanctôt from espousing her theories. If nothing else she’s putting ideas into the heads of healthcare bureaucrats who equate more people to more costs, and who therefore naturally would see anything that reduces the population as being helpful to their chief metric. (See numerous recent posts from the blogosphere, referenced above.)
**************
Grand Rounds next week will be hosted by Invisible Illness Week. DrRich thinks the premise of Invisible Illness Week is to increase the general awareness of certain invisible illnesses, and therefore, presumably, to increase spending on such illnesses. So, while this premise might perhaps have been laudable in more normal times, any remaining spies for the White House who have read this far (despite DrRich’s assurances that they did not need to), are going to want to head over there, pronto.
Comments
22 Responses to “Grand Rounds, Vol. 5.47 - Cost Containment In Healthcare”
Leave a Reply
Vital Info On:
The Covert Rationing Podcast
Covert Rationing - Introductory Podcasts Classic Covert Rationing Podcasts Recent Covert Rationing PodcastsFind It:
-
Twitter
Follow DrRich on Twitter Subscribe to This Blog:
-
The Book:
Reader Views 2008 Book of the Year -
Politics and Society
"A fine blueprint for radical healthcare reform." - Smartmoney.com
"Fogoros has a unique communication approach that reaches down to the layman." - Reader Views
"This book is a must-read" - the Dr. Wes Blog
"A damn fine book" - Medinnovations Blog
- More Testimonials and Reviews
Buy Fixing American Healthcare:
From Amazon.comFrom Barnes&Noble.com
More Wisdom From DrRich:
Heart Disease at About.com The Grand Unification Theory of Healthcare-
And Elsewhere:
Wow, what a great and timely list of posts to read! Wonderful job, and I can’t wait to get through these. Thanks for including mine, too.
I’ve been doing some research on other countries’ health care systems, and thought I’d share this list:
http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/
Turns out it’s the truth that of the 33 advanced countries in the world, the US is the only one without universal health care. Interesting.
Medical records filled with emoticons?
Pardon me whilst I go retrieve a paper towel to clean off my monitor! I should know not to read with coffee in my hand! : 0
I may write an entire post of medically appropriate emoticons….
Great edition! : D
Dr. Rich -
I haven’t enjoyed a Grand Rounds like this in a long time. Great job.
Terrific edition - witty and well-written. Sarcasm is a virtue. Love it!
Wow. Just. Wow. There is SO MUCH here, and SO WELL done.
Bravo!!!
Thanks so much for hosting, and for not aborting our post
Great Grand Rounds, Dr. R. You must really disagree with me…since you called me Toni Braxton instead of Dr. Toni Brayer. I will now try to develop my singing as well as my blogging. Toni Braxton sold over 40 million records. I haven’t had quite that many visitors but maybe Grand Rounds will help.
Toni,
OMG. As one who is especially sensitive to getting last names right (mine having been butchered routinely my whole life), I am very, very sorry about this error - which I have now corrected. Thanks for pointing it out, and for doing so in such good humor. I must have been listening to certain music as I put this together.
Rich
It continues to bother me that there is such meager awareness that greater government involvement in health care in the U.S. would in reality mean greater government contractor involvement in health care, which would be not just a step, but a LEAP, toward more impenetrably covert rationing.
The pacemaker story reminded me of struggles I once had with an insurance company that insisted syncopal episodes did not warrant its paying for a tilt table test. I can only imagine how much more they paid for treatment of syncope-associated injuries compared to the cost of a tilt table test.
This is worth a full read, if only to uncover a new synonym for “fat”: oleaginous armor.
As in, “Why I love summer. Because brown oleaginous armor is so much more attractive than white oleaginous armor.”
Thanks for including my post. Raising the possibility that failure to make healthcare safer could be a cost saver is rich (or is that DrRich?). But it’s not supported by (OMG!) data. Seems that in addition to fixing what ain’t broke and attempting to fix what is broke, we spend billions each year attempting to fixing what we break while trying to fix it.
Definitely worth reading !!
Well done, with levity, insight and comparative discipline….
We need this now!
Also check out ‘honorary health industry wonk’ Jon Stewart’s take on Obama’s death panels as they consider merit based eligibility criteria options: http://www.thedailyshow.com/watch/mon-august-10-2009/healther-skelter—obama-death-panel-debate
Thank you for a insightful Grand Round. the UK have NHS but the problem is that the rationing is done by a different way. Too much managerial control and stupid targets lead a skewed system to the eventual disaster in Mid-Staffordshire when not being able to meet 4 hour ER target, patients were hidden and left to die. Now they want a South African style forgiveness programme. Still 400 to 1200 patients died unnecessary. Whatever mistake they made, the top managers just get promoted and promoted. Doctors are sidelined as in the current Swine Flu situation: amateurs are minding phones and giving out Tamiflu.
The Cockroach Catcher
Fantastic, congratulations! Too bad I was on vacation last week and missed an opportunity to contribute.
Great job! Thanks for including my last minute post.
DrRich is one funny doctor! My guess is DrRich has an advanced degree in biting sarcasm and wilting cynicism. My favorite kind of humor.
Just read the whole lot. Wow!!!
The Cockroach Catcher
well done, your GR reads like a fine post in and of itself!
Yikes - I hadn’t that the advanced directives clause in the law was that bad, after reading junk food science I’m not so sure.
Great Job.
I left the comment below on Dr. Brayer’s blog, in response to the suggestion that the town hall protestors are “stupid”……
The President has made the following assurances:
(1) 47 million Americans who have no health insurance will now be fully covered.
(2) Those who are currently covered by Medicare or commercial insurance will have no diminution of the care they currently receive.
(3) All this will be done with no net increase in health care costs or addition to the federal deficit.
I would be more likely to characterize as “stupid” one who believes all these things can be done simultaneously, than one who does not so believe.
Bob,
While I believe you make a very good point, before we get into a prolonged dust up like the one I got into with the math mavens recently, can’t we just all agree to use the words, “differently gifted?” It would be ever so much more polite, and as you can no doubt tell I always like to avoid controversy here.
Rich
Another great post Rich- Kudos as always. A link from someone who tried to make the math on rationing as easy as possible to understand
Healthcare: Killing America
FOR MORE DETAILS VISIT IAIResearch.wordpress.com
Americans spent an estimated $2.5 trillion to maintain our health in 2009, or roughly $8,000 per person. This is more than the gross domestic product (what is spent on everything) in every other country in the world except Japan, China, Germany, France, or the United Kingdom.
Spiraling healthcare costs are on track to bankrupt America. Medicare will be insolvent by 2017 and is projected to generate a $37 trillion deficit. Increased healthcare costs are one more reason jobs flee America. And all this extra cost has given us very little return as most of the gain in life expectancy came during the first half of the 20th century due to improved sanitation and nutrition.
The cost of healthcare could be cut in half, but what do our politicians want to fix first? They want the most fraud-riddled, inefficient system—our government—to take over more of our care! They want to cover 47 million Americans without insurance rather than fix the cost of care for all 307 million Americans!
We can drive down costs to levels that existed before government decided to “fix healthcare” in 1965. This means we all have to change:
· Consumers must live healthier lives, manage their own care, and bear more of the direct cost of care. We must remember that, insured or not, we pay for healthcare through lower wages, higher prices, or higher taxes.
· We must find a way to live our last years without bankrupting our children, our grandchildren, and our neighbors.
· Lawyers can no longer be allowed to pillage our medical system for private gain.
· Providers must take a lower share of our national wealth. In return they would become less likely to be sued, go unpaid, or bear excessive overhead costs.
· Government must back away from managing care and focus on policing illegal behaviors and driving efficiency through shared knowledge.
Most important, government and industry leaders must push for change that is good for the country rather than for political contributors and lobbyists. Our founding fathers realized our republic would only survive if its leaders possessed public virtue. This crisis is another test of that virtue and I fear as Congress buys each vote with special interest gimmicks, our nation is further undermined.