Response to "Solution" (too big for comments!)

The writer here has some good ideas. Some need modification in ways that I may not be able to suggest.

However after have spent my career in both academic medicine and private practice and doing some high risk surgical procedures some things mentioned are difficult to achieve.

1. In regard to malpractice:
The only sensible solution which is most likely not attainable given the casino like malpractice environment in which we live is a panel of physicians each of whom is in the same field of medicine as is the defendant or accused doctor. There are physicians who will not be swayed by the fact that the accused is a peer of theirs, a friend etc. This panel will determine whether or not there was an act of malpractice.

Why is this not attainable? There is a lot of money involved in these cases. Even the defendant’s attorney is paid pretty good fees by the defendant’s malpractice insurance company. Then there is the injured party’s attorney who may be paid for his work by the hour or perhaps he/she will be paid 1/3 to 1/2 of any award that the injured party is given. Lastly there are the expert witnesses. These are physicians who advertise their services in the journals which attorney’s read. These self proclaimed expert witnesses advertise that they will testify for either side of a case. That is for or against the accused physician. These fees run into the thousands of dollars. There is a lot of money involved here and these above described professionals will not give up that part of their income without a big fight. Unfortunately these people have a great deal of say in legislating changes in malpractice law.

2. In regard to the member owned health organization
if a physician’s peers and patient evaluation determine the pay and whether or not a given physician should be fired the easiest thing for a hired physician to do is pick easy cases, cases with a high probability of success and refer the more difficult cases to an outside physician. Why should such a physician go through the stress of operating on poor risk patients and risking his career. The administration of the MOHOM non profit or not will want those cases done in his MOHMO. Again there is money involved.

3. Then there is the problem an MOHO may have with diagnostic procedures.
Is a physician ordering too many? Was that test essential? Again what is the nature of his patient load. Example: a child falls off of his bicycle hits his head on the curb, he acts a little dopey. Is there bleeding into or onto his brain---do we do an MRI for 1500 dollars? Maybe we ought to simply wait to see what happens. Does the child clear up or does he rapidly go into a coma with irreversible brain damage that could have be been prevented with prompt surgical intervention--- here we may be back to malpractice problems. Well the child clears up so was the MRI justified? To the child’s mother and father it certainly was justified. To a green eyeshade types NO. Additionally the administrator of the MOHMO may criticize the expenditure for the MRI . This would be especially true if the MRI result was normal. Also does the MOHMO own the MRI machine or are the patients referred outside of the MOHMO? Essentially who gets that 1500 dollars?

4. There are some very certain things that must be done and can be done. We must cover pre existing conditions, we must allow transportability of an insurance policy across state lines and perhaps across national boundaries, we must allow insurance companies to sell policies across state lines in order to increase insurance company competition.

5. Lastly one way or another we must help cover families that have continuing crushing medical bills for a member of their family. Such as an individual that will need expensive medication and other treatments for as long as the member lives. This expenditure will interfere with other children in the family such as their education. The psychological effect upon such a family of say having to spend 20% of their income for such care indefinitely is devastating. They live close to penury and in a depression for most of their lives. That’s wrong. Making it a deductable item for the income tax is not an answer, the money still goes out and only a small portion is realized by a tax saving.

This along with changing the regulation of the insurance companies must be done and it can be done. Beyond that we must be very careful. I spent one year working in Italy which has socialized medicine. Believe me it’s not good.

I have offered very little in the way of solutions but we must not allow the unemployables, the poorly educated ones who unfortunately make up the membership of the congress ruin what we have. I believe that the insurance companies ought to be freed up for us to determine what they can do and what they cannot or will not do for us. Of course they plan to make a profit, but making a profit makes for efficiency in distinction to what I saw and experienced in socialized Italy.

We can do these things and more if only the social engineers in Washington D.C. really had our interests at heart but they don’t.

In a socialized system the individual means nothing it is the group that is important. We are edging this way. Thus with a sick non contributing member of society, say a man who pushed a rife across Europe, through Korea, his son fought in Vietnam, his grandchildren are in Iraq and Afganistan, his wife worked and paid taxes her whole working life as did he---why bother ???
We can do better we always have.


Alan S. Freemond