President Obama has perceived correctly that we in America want change. We want things to have a low cost, we want protection from mistakes we make and we want someone to solve our health problems no matter what we have done. If we smoke, over eat, under-exercise, don’t brush our teeth or see the dentist regularly we want a bail out.

We perceive health insurance as a way to cover first costs and catastrophic costs. If we have great coverage, we don’t want to change it. If we are receiving outrageous renumeration for our services as many insurance company executives are, we don’t want it to change. Because of the tremendous financial clout of the insurance companies, they have many friends in Congress to represent their interests.

We have been fighting a war on two fronts in the name of national interests. Thousands of our own citizens have been killed or wounded and hundreds of thousands of the idigenous people have suffered the same or at best terrible lifestyle if you can call living in a war zone without protection of law, adequate food and little or no medical care a lifestyle. What is the national interest in our citizens health?

We have a national interest in helping our citizens to have good health and in providing them with the most accurate unbiased information on which to base their decisions. How should we do this? What should be covered by insurance and what should we have to pay? We are more and more aware of our finite financial position. We have borrowed against future earnings in order to pay for war and priviledge now.

Some are in favor of a single payer system like Medicare where the government is in control and there is no where to go to resolve problems. Others don’t want anything to change - they are doing fine with the system as it is. Some want insurance companies to be regulated like utilities. Some think insurance should only be for big unforseen circumstances and we should pay out of pocket for the rest.

I think we need a system that helps us out of a jam - if we get cancer we need some help but if we smoke or drink too much or eat too much and have disease related to over consumption of food we need to be responsible for that behavior. When I was trained years ago, renal dialysis was not paid for by medicare or medicaid. To receive it you appeared before a review committee and that committee composed of medical and social science professionals and people from the community decided yes or no. Literally life or death. If you were elderly, a felon, or had more than one complicating factor, you did not get it. I had problems with that system just like I do with this one.

It costs you to live. What should it cost you to have access to medical care? We consider cable TV, video games and eating out to be necessities - our rights! What are your rights? I think we have the right to knowledge and a level playing field. We have a right to live well and to have preventative care - but that care does not have to be provided by physicians. Prevention can be delivered by mid-levels (PAs and NPs) at a much lower cost.

Physicals and some things like colonoscopy, certain cardiac stress tests, etc… can be done by these mid-level practitioners. We need to pay physicians for thinking, not procedures. Is it worth more to do a hip replacement or to treat severe rheumatoid arthritis? There is a huge discrepancy in payment yet the person treating rheumatologic disease spends hours and hours in preparation for the visit. The surgeon spends hours learning the skill but once acquired the surgery is routine. The surgeon does not clear his patient for surgery, yet the person who does the thinking to say it is OK to have the surgery gets paid much less for the thinking than the surgeon does for the surgery. If there are post-operative complications, the surgeon keeps the fee he was paid even if the person requires many more days of care by “thinkers”. This is not to disparage surgeons who often are called upon to operate in emergency conditions on people who have neglected themselves for years.

There are no easy answers. There are lots of opinions! What is yours? How would you like to see this play out? I would really like to hear what you have to say in the comment section. Please, tell me what you think.

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