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Dr. Tomaino's Blog

Health Care Reform: Market Forces Must be Involved

August 21st, 2009
Many of my patients have asked me to weigh in on this topic in general, and President Obama's vision for a public option, in particular. One thing is for sure, notwithstanding the political expediancy of proclaiming the need for reform and a solution, it's not at all a straight forward problem to solve.

Clearly health care costs are exhorbitant, but this is more complicated than arguing that technology is too expensive or that providers and insurance companies get paid too much. An insufficient emphasiis on healthy living as well as an expectation that technology ought to enable us to live longer and healthier has fueled an industry that rewards a plethora of options. Fueled by increasing demand and consumtion, it's no surprise that total costs keep increasing, and no surprise that "managed care" is another way, often, of rationing or withholding care.

Those who can pay can continue to consume, and those who cannot are faced with increasing costs, in part, related to the economic impact of supply and demand.

Because our health care industry is not one with unlimited capacity--hospital beds, outpatient clinics, doctors and nurses, barriers to irresponsible consumption will exist. These, in my opinion, will be imposed both on the basis of price as well as on the basis of outcome data and best practices.

Reform, in the absence of any assignment of personal accountability for health and consumption of resources, will likely fail. Additionally, there will always be offerings within the industry, like any other, where those folks with unlimited resources will be capabale of "over-consuming" if they can afford to. Governments role ought to be looking out for those who try their best to live healthy and yet still have trouble gaing access to an expensive system.

Until we regard health care expenditure more like spending money on entertainment, electronics, food and shelter, etc.----offerings which we need to pay for to receive-- we will be at risk of treating health care as an entitlement.

Entitlement----maybe. But if we are looking for a solution, we need to embrace the fact that the healthcare industry is made up of people who have jobs and also need to consume------therefore, somehow we need to generate the revenue to cover the cost.

Higher taxes? Less consumption? Public option? Maybe.

Single payor? Eliminate market forces?

When has eliminating competition ever worked?


Maryann Mazzaferro

I agree with your statements Dr. Tomaino.The answer to the problem is not straightforward. Treating health care as an "entitlement" can be a risky business, but is this what president Obama has in mind? With the rising costs of health care I don't think there is an easy solution.Yes, too bad governments can't put an emphasis on those who really try to live healthy. But with such an expensive system where does the answer lie? Any replies??Or opinions? Not a day goes by that the issue of health care reform isn't part of the national news forum.

August 21st, 2009 @ 5:51 pm

In the past weeks as I’ve had a lot of time off work to recover from surgery, I have had the opportunity to do some long missed reading; books and newspapers. I have been following the news stories on the television as well. I recently heard it said by one woman, about my age, that she had never been interested in politics. She just went with the flow. With the upheaval of the whole ‘Health Insurance’ debacle, she has had no choice but to WAKE UP! This is pretty much how I am beginning to feel. She remarked, “The sleeping Giant has been awoken!” ..
While this current bill, in its’ present form, is not what we need. We do need some sort of healthcare reform. That is --‘healthcare’ NOT ‘health insurance’. Somewhere along the line ‘healthcare’ and ‘medical insurance’ conveniently merged together to become ‘health insurance’. How is that even possible? We cannot insure our health. We, as individuals, can maintain our health though a healthy and active lifestyle. We have the ability and the right to choose what we will eat, how we like to exercise, and entertain ourselves. If we make poor choices we shoulder the consequences for them. Not our neighbors down the street or a stranger across the country!
That right to choose should also continue to extend to how we proceed if something does go wrong with our health. It shouldn’t be a right or entitlement to be cared for by the medical community. It should be a right for us to choose to be cared for and how we pay for it. This plan suggests that every American be dumped into a giant healthcare pool and have medical care doled out on and as-needed basis. Everyone, regardless of income (or contribution), will be ‘entitled’ to the same level of care. The argument is that the current system does not cover the un or underinsured because the insurance costs are too exorbitant. Okay, so how, in all of history, has the market driven costs down? We increase competition. Just like that computer your sitting at right now…it sure does cost a lot less today than it would have, say, back in 1989! John Mackey, CEO of Whole Foods, made this suggestion in an op-ed he submitted to the Wall Street Journal (available online). As he suggests, why not allow insurance companies to compete across state borders. Costs surely would go down if more options were available.
President Obama recently made a veiled joke about citizens being concerned that they would lose their current private insurance coverage because the companies couldn’t compete with the Public Option plan. He used the example of FedEx, UPS, and the USPS stating that the last time he checked, FedEx and UPS were doing fine, it was the Government program that was failing. Is this supposed to instill confidence?
My fear is for the loss of choice. Not getting services when they are needed, but being put in 6-month-long line to wait for a needed test. My biggest fear is that we would all lose the choice of going to an independent Specialist like Dr. Tomaino. Under the current plan, he probably wouldn’t be available to us. We would be subjected to the Doctors of the future who were pushed through the new Medical School system (factory?) that doesn’t weed out students based on ability. They will be rushing to fill the void of Primary Care Physicians created by the black hole of patients who were dumped into that big pool.


August 21st, 2009 @ 8:53 pm

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