Return to Those Thrilling Days of Yesteryear…

By: Brooks A. Mick

Interesting to me is that many of the “new ideas” regarding health care reform are really suggesting a return to OLD WAYS. I refer to the time 45 years ago when I first began medical practice.

1) Medical malpractice awards were reasonable, covered actual damages, costs of future care, etc., and the massive “pain and suffering” damages, logically unquantifiable, and “punitive damages” were pretty much non-existent. As they should be. Physicians in the main are not being wantonly erroneous in their diagnosis or treatment. Much of the “malpractice” cases won by John Edwards, for another example, were simply due to histrionic lawyering and had nothing to do with any actual mistakes on the parts of the physicians. The theory Edwards used to sway juries and pry big bucks from doctors and insurance companies has been disproved many times. Most birth defects have nothing to do with the hours or minutes around birth and occur through multiple other causes that are essentially unavoidable. Thus I would agree with limiting pain/suffering and punitive damages. These are just transfer payments to lawyers in the main. The patients don’t see all that much of these big awards.

2) If government did not have its big fingers and thumbs in the medical pie, the free market would generally assign costs and benefits fairly equitably. That is, those that could afford to pay DID PAY MORE and the hospitals and physicians then DONATED their services to the indigent. I cannot recall any wealthy patient ever complaining about being charged more than the poor patients. It was expected! The hospital in which I served my residency had TWO LARGE WINGS that were charity wards, and all those who couldn’t pay received care by, in my opinion, the best nurses in the hospital, and they were looked after by the best physicians in the community, who considered it an honor and duty to donate their time this service and to supervise residents and interns.

3) I propose that government CANNOT perform this type of activity, playing Robin Hood as it were, charging the rich more and then using that money to care for the poor, nearly as efficiently as the private sector used to do and could again if government were not so meddlesome.

4) We should institute Medical IRAs wherein patients put in a percentage of their paychecks, the money grows tax free, they can use the money to purchase whatever medical care they wish, and we work out some arrangement such as the old and relatively inexpensive Blue Cross type catastrophic coverage for when people are hit with big unexpected bills. This would be TRUE INSURANCE, not the ersatz “insurance” as it is currently labeled which is NOT INSURANCE BUT PRE-PAID HEALTH CARE. Since when would INSURANCE pay for athlete’s foot and acne and hangnails and all the other things that people now consider “insurance” coverage? How costly would auto insurance be if it covered paint scratches, oil changes, inflating tires, etc? An additional benefit of the Medical IRA accounts is that, if not needed for medical care, they can be used for other purposes or bequeathed to the grandkids. People would be LESS dependent upon government in their senior years. (From Big-brother Government’s perspective, this is a disadvantage, of course.)

5) People would return to some self-reliance wherein they would go to the drug store and get Desenex, probably not even tapping their Med-IRA accounts, rather than going to the doctor, taking up office time, and asking for a prescription item to treat athlete’s foot! This is a waste of health care dollars. And such minor things are at least a third of office time for most of us primary care types, I would guess.

6) All the different disease groups who lobby congressmen into mandating coverage for their pet diseases should be told to take a hike. Every one of these 50 or more organizations adds its 1-2 % to the cost of health care, and added up it may reach 50% of all health care dollars. Let health plans, actual physicians, and patients make decisions on an individual basis. Governmental mandating pre-paid health care for multi-dozens of pet illnesses is a big part of the problem. The true priority diseases would be treated anyway, and it is highly probable that there would be sufficient money around to cover needed treatment for the more rare problems if there were fewer layers of bureaucracy to soak up dollars.

7) This is controversial, to be sure, but I note that many lawsuits against various drugs and medical equipment filed by the ambulance-chasers who are trolling for clients by TV advertisements are later, after millions of dollars paid in defense or in settlements, found to have been baseless and founded on flawed research. Currently Avandia is a big deal with lawyers asking for any patients who were on the drug and who suffered heart attacks, etc., to call them. The most recent research, however, finds no increase in vascular events in patients who took Avandia. Many people who would have benefited have been scared into quitting the drug or into paying for a more expensive agent. So WHY NOT HAVE A LAW WHICH SAYS THAT MONEY AWARDED IN LAWSUITS LATER SHOWN TO BE BASELESS BE COLLECTED FROM THE ATTORNEYS AND RETURNED TO THE DRUG COMPANIES OR PHYSICIANS? There would go John Edward’s big house! (I realize that is a pie-in-the-sky dream.) At the least, enact a loser-pays system, which would discourage frivolous lawsuits.

I’m an idea man, and I have lots of others, but that would be a good start. Those who can pay would pay more, but isn’t that what Obamacare wants to happen anyway? The poor who actually can’t pay would be cared for. The only downside I see is that those receiving charity would likely feel obligated to be grateful, and also government would not have its big ham-fists around the necks of all citizens. But that is good, isn’t it?

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