I understand what you are saying, Dave. I hope that there will be a system that will provide for every individual and family that needs health care. If there were no insurance at all, costs would drop, physicians would be able to provide care without the paperwork demands created by Medicare and Medicaid. I guess that one of the big concerns I have, from a physician’s perspective, about a government-run system. I probably spend 1/4 of my time doing paper work. Much of that paper work is to justify to the government why I am doing what I am doing. If all my patients were to require proof in triplicate for why a certain service is needed it would further restrict the time available to provide care for the patient. The regulation that surrounds health care now is already large and I fear that if the entire system were such it would become insurmountable.

Just my concerns. I agree that something needs to fix the problem. I just don’t see government as the solution in this case.

There are as many mid-level managers in the current healthcare system as there would be in a single-payor system.

The problem with shopping around for a deal on healthcare is that eventually the system distills into great services and doctors for those who can afford it versus substandard services, technology, and providers for those who can’t. It just puts us back in the same spot, good healthcare for the “haves” and mediocre or no healthcare for the “have-nots.” And (my medical knowledge isn’t extensive, but) won’t the gallbladder eventually become a big emergent problem if untreated because the patient can’t afford the $1,000?

Abou the drug companies, there’s a clip in the extra features of Sicko where Moore talks to former Editor-in-Chief of the New England Journal of Medicine and author of ‘The Truth About the Drug Companies,’ Marcia Angell, M.D. who says that most of the ground-breaking, innovative research is done by the NIH and universities. (I didn’t include it in my Sicko review because I thought people might think I was piling it on.)

There are those who think that the best way to control health care costs is to make the market completely open and free. I don’t know that I buy into it, but hear me out. For any non-urgent, non-emergent treatment, the patient could seek out the provider that would do the work for the cheapest. If someone will take out my gallbladder for $1000 instead of $10,000 then I would chose that provider.

Two procedures (or classifications of procedures) that exemplify this are Lasic and plastic surgery. The cost of having these procedures done has plummeted over the years precisely because insurance doesn’t pay for the procedures.

Emergent surgery and trauma care would need to be covered in a government sponsored universal payor system. All other care would be placed on the free market and prices would precipitously drop. Chronic diseases are poorly treated in conventional (insurance-covered) medicine and my next point would hopefully provider better care and outcomes.

However, two other things would need to take place. Tort reform to lessen frivolous law suits and the elimination of the AMA’s monopoly on health care. Most OB/GYN’s don’t want midwives delivering babies because every time that happens, that’s a few thousand out of his/her wallet. It’s much more economical and a very safe alternative for many mothers-to-be. But with the AMA seeking to protect the institution of medicine, they will never allow for a free market of health care, but will continue to behave as a monopoly, keeping prices up and unreachable for the many without “establishment, institutionalized” insurance.

One last point: the pharmaceutical industry is one of the biggest scams in our country. Most of these companies are making money copying the medications that others invested the R&D for. Because they are all making incredible profit on these “me-too” drugs, there is no market pressure to develop new drugs that actually work in new ways and actually perform well instead of just adequately.