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Health care reform, an ICU case
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Forsyth County News
They say that a camel is a horse put together by a committee. Can you begin to imagine what that animal would look like if the task had been assigned to Congress?

In principle, it is often easy to formulate simple solutions to complex problems, at least on an intellectual level. Consider the legal system. What if it was based upon the Golden Rule, and the nature and severity of all penalties were functions of how far a particular behavior deviated from that “standard?” Simple, easy to understand and reasonably logical. But the devil is in the details.

Even though such a structure might serve in the vast majority of cases, there would still be situations where reasonable people would disagree in the definition of desired behavior, the degree of deviation from the target and the appropriateness of the penalties imposed. This would lead to an enormously complex legal system like the one we have, with so many laws and loopholes that it’s often hard to equate the outcome with any meaningful standard of “justice.”

Today, Congress is wrestling with the knotty problem of health care reform. With wanton disregard for the adage that “fools rush in where wise men fear to tread,” I want to toss out a few thoughts. I don’t have solutions, but my hope is that thinking through these issues might help to lead to better solutions than what is likely to emerge from the paths currently being pursued.

Perhaps the four most important objectives of this effort can be characterized by four Cs: Coverage, cost, choice and cures. In the battles being fought by special interest groups and the propaganda being disseminated, I am concerned that the objectives are secondary to the desire of each participant to achieve either a protected or an enhanced position.

Coverage: We are a wealthy nation. Yet, according to the census, 47 million people are without health insurance. Moral and humanitarian principles would argue that something should be done to make sure that needed health care services are available to all.

Cost: Health care costs are high, and despite the fact that we spend more on a per-capita basis than any other nation, by most measures, the results place us way down on the list. Funding the addition of 47 million more to the “system” is likely to make the burden (on government, on private industry or others, depending on focus of the various proposals) substantially higher. Clearly, we must find ways to reduce current costs and those associated with expanding coverage.

Choice: We are a nation of independent souls. Most of us want the freedom to choose our own medical care support services. A recent Time magazine poll showed that 86 percent of Americans with health coverage are satisfied with their current plan.

Cures: We need to find better ways both to prevent disease and to conduct research that will explore all potential cures, even those that have little commercial value. Prevention is probably the most effective way to cut costs, and the profit motive, left to itself, often gets in the way of doing what is best for the general public.

Two of the major obstacles retarding the development of simple solutions to the health-care crises can be characterized by 2 Gs:  Greed, largely on the part of the private sector, and government shortcomings, relating to both structure and inefficiency.

Greed: Special interest groups have exerted undue influence on congressional decision makers. The pharmaceutical industry spends enormous sums, for example, on advertising proprietary drug products directly to patients — a practice banned in most other countries. Many insurers engage in practices that limit or eliminate coverage in ways that are clearly unethical, although not illegal. The balance between making profits and providing service is often skewed in the wrong direction.

Government shortcomings: Government is partner to the problem in many ways. Failure to limit excessive malpractice awards pushes physicians to order expensive and often-unnecessary tests. The lack of meaningful campaign reform combined with the seniority system allows special interest groups to buy congressional support and block legislation that would harm their position. And government inability, proven in many cases over the years, to run effective programs, control costs and keep them free from the influence of special interests adds to the problem.

The private sector has largely had its way to date. That’s gotten us into this mess. But the prospect of a government takeover seems to be a non-solution. Yet most of the arguments and proposals focus on one or the other.

The fact that the bills floating through Congress run a thousand pages or more is symptomatic of the problem. Most are written by “committees,” each trying to ensure that its own, often self-serving, issues are adequately covered. Many analysts have commented that the documents are so long and so complex that it is doubtful that anyone has even read them in full, that most contain conflicting provisions, and that parts lack meaningful logic. Is it any wonder that the public is confused and, in many cases, even angry?

I wish I had a solution. But one idea that I have not heard discussed to any appreciable extent is the possibility of dealing with a piece of the problem rather than going for an all-or-nothing solution.

For example, instead of addressing the problem through insurance (an area of confusion and frustration to many), what if government worked with the private sector to provide access to a network of clinics around the nation? People not currently covered by health plans and who met certain qualifications would be entitled to use those clinics. The new organization could negotiate with medical product suppliers on mass procurements (which other governments have found to be very successful in reducing costs), apply sound medical practices which are considered effective but not excessive, and operate under a liability umbrella which would reduce the need for extensive measures just to avoid excessive jury awards?

A model such as this could experiment with various delivery alternatives and, if successful, could be offered to people now covered by other plans. No one would be forced to change from what they have. Yes, it might displace inefficient providers, but that’s how the free enterprise system is supposed to operate.

We need to focus on the fundamental objectives. We must find ways to get government and the private sector working together and to eliminate the influence of special interest groups fighting to maintain their well-being at the expense of the well-being of the citizens of the United States.

Dr. Melvyn Copen lives in both Georgia and Arizona. He is an educator and businessman who has worked and lived in many foreign countries and provides consulting services throughout the world. His column appears every other Wednesday. Please share your comments with him via email at