Here it is, the last installment in my discussion of health care. There are a hundred other things that probably should have been said before this, but every time I write another installment, I run the risk of repeating the same things over and over, especially when dealing with the problems of health care. It is easy, when feeling particularly passionate about a subject, to find yourself stuck on the the things that bother you the most. That is where I stand. But there are some things that need repeated.

As long as we stand for the selling health care in the same fashion as appliances, there will be no permanent solutions. The longer we continue to hold conflicting ideas about health care, the harder it will be to fix. We need to take some logical stance on health care as a necessity, not as a commodity. All of this is based on the assumption that it is a right.

It is important to understand that criticism of the United States health care system is not the same as criticizing our medical care. Doctors and nurses are not generally out to exploit human suffering to make a dollar. Such is not the case with many of the companies and organizations designed to pay for health care. Essentially we have a system that keeps costs lower than what they could have been, but is transformed by the inherent nature of the business approach to medical care. What's good for the business is not necessarily good for the consumer, and where human interests are in question is this really the best approach? If we assume, like other developed countries, that health care is a right then the answer is no.

Changes to our system need to take place in order for us to seriously treat health care as a right and make it affordable to everyone. There are solutions to some of the problems without scrapping our system and starting from scratch. These are obviously the only considered solutions, so a look at more drastic changes would be pointless at this time. We like the thought of a better system, but we don't want the fuss that goes along with turning away from market-based health care.

Some solutions include tort reform and reform of medical financing, AKA insurance reform. Tort reform is what President G. W.  Bush is proposing. However, without significant reform in the financing side, there is nothing to gain from tort reform aside from taking power away from the victims. It has been tried, even in my own state, and nothing significant has come from it.

Here is an excerpt from a news clip:

"Doug Wojcieszak, a spokesman for Victims and Families United, an Illinois advocacy group, said Bush was 'playing with the facts for political purposes' in singling out Madison County.

The group said that out of 720 medical-malpractice and wrongful-death cases filed in Madison and neighboring St. Clair Counties from 1996 to 2003, just 14 resulted in jury verdicts, and six of those verdicts favored the plaintiffs.

According to the group, there has been only one medical-malpractice lawsuit in Madison County that produced a verdict in the last seven years that would have been affected by Bush's proposed $250,000 cap on noneconomic damages."

Read more: http://www.philly.com/mld/inquirer/news/nation/10577777.htm?1c

On the other hand, President Bush outlined a nice plan to "computerize" health records which would decrease cost and increase efficiency:

http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html

But these aren't solutions, these are ways to cut costs for the hospitals and organizations. This doesn't necessarily mean savings are passed on to patients and it has even less to do with quality and spreading access to health care, so let's talk about some other proposals.

Some people, myself included, have proposed spreading Medicare-like coverage to children under the age of 18. Children have the most need of health care access, and around ten million children are not insured. During these critical years of development is when children need care the most, but when you aren't poor enough to get Medicaid coverage and not wealthy enough to afford to get preventative care for your kids, it leads to health problems later on.

Here is an article on similar proposals: http://www.familiesusa.org/site/PageServer?pagename=Medicaid_Index

There are other reforms in the medical community that have been offered. One has to do with the shortage in access to physicians. In the United States, there has been a trend of training more specialists than general practitioners. Another problem lies in the fact that physicians aren't equally distributed based on need. A solution would be to offer incentives for doctors to work in areas that need them as opposed to where they'd normally make the most money. The incentive would ideally cover the cost of moving to an area to practice and the difference in income it would cost them, but whatever incentive works would be best.

The lack of government involvement, a dream of businesses, has run its course in health care. It is to the point that government involvement would be beneficial, if only to oversee ensure medically appropriate treatments are being used, and not just whatever is cheapest for HMOs and for-profit hospitals. Federal management of the medical industry would also be beneficial. There needs to be a better Patients Bill of Rights as well.

All of these reforms would work towards expanding coverage and fairness, and decrease the human exploitation that takes place in the health care industry. It would go a long way to insuring that the United States' health care system doesn't continue to rank 37th, and it wouldn't do anything to crush competition. It would also decrease costs by increasing efficiency, and reforming areas of the system that need it, not just tort reform which doesn't affect the costs of health care significantly. Over half of the states now have caps and it hasn't lowered health care prices significantly. As long as we take rational and logical approaches to medical treatment, we can get to the roots of the problems.

But I certainly haven't got all the facts and figures. I don't have all sides of the argument, and I certainly didn't list all the solutions of half of the problems. What I have is a beginning of something to get people to think for themselves. Don't assume that I'm right or wrong, figure it out. If you think I'm absolutely wrong, show me. I don't want to go around believing lies and more than you do.

So I ask you to leave your two cents. Add whatever you think is important to add to the discussion. If you want some ideas, here are some "tough questions" from PBS.ORG. If you answer all of these, you are a superhero:

1. Do we have a moral obligation to provide healthcare to everyone as needed or is healthcare a commodity that should be subject to the same marketplace influences as other commodities?

2. What should the government's role be in providing access to healthcare for Americans?

3. According to a study in The Journal of the American Medical Association, nearly 40 percent of physicians have manipulated insurance reimbursement receive needed care. For example, physicians have exaggerated patients' symptoms to allow them to stay in the hospital longer, and changed patients' diagnoses for billing purposes. In our current healthcare system, is this justifiable or unethical?

4. Do insurance companies and HMOs use unfair practices to control spending?

5. Should employers be required by law to offer health insurance to employees?

6. Should employees be required by law to participate in employers’ health insurance?

7. Should everyone be required to have health insurance, much as drivers are required to have auto insurance?

8. Our system of health insurance is linked to employment. Coverage is usually provided by the employer, with some contribution from the employee. We now have many people working part-time, or freelance, or working through other nontraditional arrangements.

Should health insurance continue to be linked to employers (our “employer-based system”) or is there another preferred approach?

9. Who should decide when a healthcare service is medically necessary: the doctor who is treating the patient or the insurance plan who is paying the bill?

10. “Evidence-based medicine” tries to reduce variations in practice, reduce inappropriate care, and reduce waste by using results of studies of large groups of people as the basis for medical guidelines. On the other hand, some feel that it is bad medical policy to apply general rules to all cases and that medicine requires that the physician use his or her knowledge of the particular patient in deciding on the course of treatment along with the patient. What do you think?

11. Some feel that healthcare is a commodity like VCRs or computers and that it should be distributed according to the ability to pay in the same way that consumer goods are. Others feel that healthcare is a need and that it should be distributed according to need. What do you think?

12. Currently, individual health insurance policies are much more expensive and/or do not offer the same services as group insurance. However, in most states the law does not allow people to form a group for the purpose of getting health insurance. Should individual policies cost the same as group policies? Who should pay the individual’s additional cost? (the individual? the government? the insurance company?) Should it be legal for people to form a group themselves, such as through the Internet, for the purpose of getting a group insurance policy?

13. How much, if anything, would you be willing to pay every month so that everyone could have access to basic medical care? Nothing? $25/month? $50/month? More? What should “basic medical care” be? Who should decide?

And that's all folks. Boy am I glad. What an anticlimactic ending, but let's face it. I'm tired of typing.