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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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August 01, 2007

Deconstructing Healthcare in America – a Modest Proposal

By Mark Sisson
67 Comments

I’ve been giving a great deal of thought to our system of healthcare lately. Frankly, I am disgusted not only by the perverse waste of money (we will spend 2 trillion dollars – that’s 17% of our GDP – next year on health related expenses), but also by the obscene lack of success our current system has in helping people achieve, maintain or regain good health. We are getting sicker and sicker as we continue to spend more on healthcare.


While we rank number 1 worldwide in health-related spending, we rank 37th in overall health performance. Sure, Americans live longer now on average than we did 20 or 30 years ago. But the truth is we are only surviving longer, because we are most certainly not thriving longer. Drug companies are keeping us alive just so they can pump more meds down our throats while they pump up their own bottom line. And we are now told that the generation in grade school today may be the first – in centuries – not to outlive their parents. Something drastic has to be done soon. This current system is beyond repair. But if you are one of the 45 million uninsured Americans, for whom the thought of getting sick is, well, sickening, you already know that.

As I’ve been reading all the pre-election political proposals to fix our current “healthcare” system, I am struck by the fact that they are trying to fix something so badly broken that it simply can’t be repaired. Even Michael Moore’s new film “Sicko” doesn’t get to the heart of the problem. The assumptions upon which the current system are built are outdated, obsolete, and illogical. The system requires a wholesale reevaluation and rebuilding from the bottom up, including our rights, our responsibilities – and our reasonable expectations. If virtually every other developed nation (and several underdeveloped) can take care of their sick, we certainly ought to be given the chance.

With that in mind, I would like to offer a “modest proposal” to overhaul the U.S. healthcare system into one that, in my opinion, would do a much better job of caring for its sick and making sure the rest of us stay healthy. I realize that what I’ll be suggesting is a radical change and one that may irritate more than a few professionals who currently operate within our existing healthcare system. Nevertheless, this discussion is vital and I can no longer sit back and watch the system and its patients self-destruct. We gotta talk.

While the problems with today’s healthcare system are many, I have chosen a few to illustrate why we need a massive intervention:

1) Let’s start with the patients. Americans have lost all sense of personal responsibility. We want to blame anyone or anything but ourselves for our illness or condition. Furthermore, we have ceded all control of our health to the people in the white coats. We tend do whatever they say because we hold them in such high esteem. But doctors (like lawyers and accountants) do not have answers. All they really can offer are opinions and advice – only slightly more educated than our own and often biased by Big Pharma, medical supply companies or the fear of being sued. As a result, we way spend too much money on unnecessary visits, drugs, tests and procedures.

2) There aren’t enough doctors in the U.S. One report suggests that as baby boomers start needing even more care, there will be a shortage of close to 200,000 doctors as early as 2010. One of the reasons for this shortage is simply because it takes far too long (usually 7-10 year) and costs far too much to train doctors. Furthermore, most doctors have to pay for this training themselves, often incurring huge student loan debt. It’s not unusual for kids these days to incur six figures in debt simply to get through a regular four-year degree – you can see the problem for the youngsters who desire to go on to medical school. As a result, and to compensate for all this, doctors have to charge too much money for too little service, and then hope that some day they will be reimbursed by the for-profit insurance companies. This doctor shortage is also why when you really need to see one today, the earliest available appointment isn’t until two weeks from Thursday. It would be funny if it weren’t so tragic.

3) The current system depends on private insurance companies to reimburse all costs. This profit-driven insurance-based medical reimbursement system is fatally flawed on several levels – and always has been. The basic business model of any insurance company is to do everything possible to collect premiums and then do everything possible to deny coverage. Therefore, people who need medical attention are frequently denied expensive (but often the most effective) treatment or, alternatively, people with pre-existing conditions can’t get insurance coverage in the first place – when they are the ones who need it most. As a result, insurance companies often dictate the most critical medical decisions more than the physicians. It’s just so wrong.

Rat bastards!

4) The majority of conditions for which people seek treatment can be better treated (and in most cases cured) with lifestyle intervention and education, yet our system of medicine would rather treat symptoms with drugs and/or surgery. Obesity, diabetes, heart disease, osteoporosis, arthritis, digestive problems, asthma and a wide range of other conditions often respond far better to diet and exercise or environmental changes than to even the best “state-of-the-art” pharmaceutical interventions. But doctors are under the gun to meet payroll, pay the rent and pay off the student loan, so they limit office visits to eight minutes and move on to the next patient. Under these circumstances they are far more inclined to prescribe meds than they are to spend 45 minutes or an hour to fully “describe” a lifestyle change that could cure the condition. Of course, they are even less inclined to follow up on any educational visit. What’s the incentive?

5) Pharmaceutical companies, medical equipment providers, hospitals and even a few doctors have a vested interest in keeping their patients ill. You’d think that a successfully “cured” patient should represent a major victory in strict medical accounting terms, yet a cured patient generates no income and no profit. Type 2 diabetics are a good example. Drug companies view a diabetic as the perfect patient – a 20, 30 or 40 year income stream generating $500 to $1,000 a month. The longer they live with the disease, the more additional drugs they’ll need and the more profit the company will make. In fact, the drug company has zero interest in the patient altering his or her lifestyle (and as I have said here often, type 2 diabetes is an entirely preventable and curable condition). They just need to keep them alive.

Moreover, when the market on one disease is tapped out, our friends in pharmacology manufacture new ones: “restless leg syndrome”, “social shyness”, “erectile dysfunction” and “PMDD” are not diseases, but they represent huge profit centers for doctors and pharmaceutical companies who see a lifetime stream of income from patients taking their prescription meds month after month, year after year.

6) The fear of lawsuits causes many physicians to assume a “cover your ass” approach to avoid any potential implication of liability, however remote. Medical malpractice has become a huge industry as personal injury lawyers seek outrageous settlements for even minor mistakes or misdiagnoses. Many physicians leave the business because they can’t afford the malpractice premiums, and they fear the one multi-million dollar mistake that could ruin them. As a result, doctors resort to generalized “standard of care” methods even when those standards have been proven ineffective. For example, there is no good evidence that statin drugs lower the risk of death from cardiac events when cholesterol is between 200 and 250, while there is compelling evidence that diet and exercise interventions dramatically reduce deaths in that same group.

Nevertheless, most physicians prescribe statins and spend minimal time aggressively outlining lifestyle changes because statins are the “standard of care” for high cholesterol cases and because there’s safety in knowing that’s what most other physicians are doing. A physician who does not prescribe statins might be subject to a lawsuit if his patient died of heart problems because, shunning statins, he had tried but failed to get the patient to follow his diet and exercise advice. Fear of lawsuits is also why your doctor will sometimes run hundreds or thousands of dollars worth of diagnostic tests “just to be on the safe side.” You might think your insurance company pays for it all. But those costs are passed on directly to you and everyone else via annual insurance premium increases. God forbid the insurance companies should have an unprofitable year.

These are just a few of the problems with the current system. There are many more. These problems will not go away with the kinds of compromise proposals offered by politicians today. Forcing business to cover the costs of employee healthcare is ludicrous. Other than worker’s comp coverage, by what logic is it the obligation of business to pay for the bad luck, unfortunate genetics or unhealthy lifestyle choices of its workers? The single-payer system that has been often proposed has many merits, but is continuously shut down by Congress. Government guaranteeing the profits of private insurance companies using taxpayer funds is viewed as a misuse of taxpayer money. Yet there is a strong argument that perhaps the time has come for government to step in and do something drastic to fix this mess.

When it comes to business and economic models, I’m one of the biggest Freidman free-market proponents you will ever meet, but sometimes the basic needs of the people require that the government get involved. You could even argue that in the 21st century, given the health tools science has provided us, access to quality healthcare has become a constitutional right (provided you are willing to take personal responsibility for it). It has become my opinion that access to basic healthcare for all, like defense, fire departments and interstate highways, should be viewed as a public good, not as for-profit business with corporations’ profits favored over the health of our poorest citizens.

Yes, I’m advocating a federally funded and federally driven program that would allow anyone of any means access to basic healthcare at little or no cost. Now before you get all Republican on me, let me explain that I am also in favor of keeping parts of the current system for people who prefer and can afford a private medical system. After all, cosmetic surgery, Botox, stomach stapling and Viagra still need to be made available to those willing to spring for it.

It’s not often you’ll hear me suggest that government could do a better job than for-profit industry, but there are so many players in the current healthcare system that require a profit at the expense of the sick – and who have so shamelessly lobbied Congress to allow them to continue this charade – that the concept of “free-market forces” left the building with Elvis decades ago. For example, according to a 2003 study we spent almost $300 billion on “administrative costs” associated with medical experiences in one recent calendar year. From the patient point-of-view, that’s $300 billion of your hard-earned dollars completely wasted.

My proposal is a two-tiered healthcare system which offers government-sponsored healthcare to everyone (we’ll call it “public healthcare”), yet still allows for private medical practice as we know it today to be available to those who prefer and can afford it (“private healthcare”). Anyone of any means could access the public healthcare system with minimal co-payments (which could be reimbursed via tax credits for low-income patients). There would be no private insurance involved in the public system at all because taxes would cover almost all expenses, but the private system would still largely depend on private insurance reimbursements. For those who wonder how or why a two-tiered system could work in this country, look no further than the US system of retirement planning which offers social security to everyone (and mandates taxes to insure it), yet allows those who prefer and who have the means to set up additional private retirement accounts (IRAs, 401ks, defined benefit plans, etc) with tax benefits and almost unlimited upside.

The public system would work much the same way that the armed forces work today. In fact, it could be its own branch of service. Prospective medical students who elected to go through the public system would enlist and would be trained within that system. Their entire training, as well as room and board would be free (paid for with tax dollars), and in exchange for the training, they would guarantee to provide at least eight years of service within the public health sector compensated at a reasonable rate of pay (let’s say $80,000 a year, comparable to a public defender). After eight years of service, they could elect to remain in the system (with an increase in pay) or they could go into the private healthcare system and hang out a shingle (remember how most commercial airline pilots came out of the military?). Nurses, physicians’ assistants, exercise and diet coaches, even administrators could all be trained within this same system. All this could even take place within today’s current armed forces structure with added pay incentives for actual combat-readiness training, but might be more effective as a stand-alone service branch.

With regards to the growing shortage of trained doctors, my system would fix that in relatively short order. This does require a major re-evaluation of what it takes to be a doctor. Bottom line: it shouldn’t take eight years to train a competent specialist like it has up until now. Aside from general practitioners and Emergency Room docs, almost all medicine is specialized today (just tell an orthopedist you have a GI problem and see how fast she runs the other way). I would argue that you can train a smart pre-med college grad 90% of a chosen medical specialty in under two years and have him or her be perfectly competent to begin supervised practice on real patients. After all, most diagnoses theses days are done by computer modeling anyway – not by the actual physician. I don’t wanna say a monkey could do it, but let’s get real.

If a condition is not immediately obvious to attending physician today blood, urine, stool and saliva samples are sent to labs and returned with nice distribution curves and all the relevant data with which to make a cogent diagnosis. CAT scans, X-rays, MRIs and other imaging techniques allow almost anyone to spot a problem and begin treatment.

Even surgical techniques no longer require years of practice with a supervisor looking over your shoulder. Surgeons today can be quickly trained using computer simulators. Ironically, most new surgeries these days are taught to older surgeons by 30-year old medical sales reps (who most definitely are NOT doctors) shilling the latest stents, shunts, implants and titanium joints. The idea is to train more doctors quicker and pay them less. Pure and simple. Those doctors who wish to charge more for special services could either train and operate within the current system or enter that system after their years of public service. But as we have seen in the private system, most of our healthcare money goes to greedy middlemen (insurance companies, pharmaceutical companies, bureaucracy-laden hospitals, student loan collectors) or to wickedly non-productive overhead (office rent, administrative staff, malpractice insurance). As a result not much of our health dollar flows through to provide patient services. That would change radically under my system.

The public system would rely on generic drugs wherever possible and would negotiate very favorable pricing on brand-name meds when those are absolutely necessary. Drugs would only be prescribed when truly medically necessary (sorry, no Viagra or recreational Oxycontin) and elective surgeries would usually be discouraged. Experimental drugs would be allowed if they were the only recourse in critical cases, but only with patient permission and waiver, adequate supervision, and oversight from a restructured FDA. The more expensive drugs would be used on a “pay-for-performance” basis, where the drug company would supply them, but would only be paid if they worked within acceptable parameters.

Education would be a major focus of the public health system. The current for-profit system is based on maximizing treatment as opposed to maximizing prevention. Under the system as it is, we will never make progress preventing or curing the lifestyle diseases that threaten us the most: diabetes, obesity, heart disease, stroke, arthritis, even some cancers. In most cases these respond very favorably to lifestyle interventions, but no one is willing to spend the time or energy to educate. Under my proposal, doctors would be paid for their treatments, but would also incentivized for successfully weaning their patients off meds and for having their patients achieve medical milestone numbers such as losing a certain percentage of weight or bringing fasting blood glucose to under 100 for two successive visits.

These goals can only be achieved when the patient is educated, understands the mechanisms and then takes responsibility for her health. Under my proposal, specialized health educators (maybe those who didn’t fully qualify for the medical training, but who exhibited the interest and the intellect) could be trained within the system and then deployed to schools or assigned to work with physician groups to do hands-on small-group diet, exercise and stress-management coaching. The success private clients currently enjoy working with personal trainers could then be made available to those who currently have no hope of ever gaining access to the true secrets of health and wellness.

Within the public system malpractice and medical “mistakes” would not be subject to the same litigation system we see in private medicine today. Instead, a 3-person panel of experts would hear cases and, upon finding gross or willful negligence, could choose to award reasonable costs according to a set schedule. This would ensure that any patient harmed by the system would be looked after, but would not be awarded lottery-like sums from aggressive tort-lawyers impressing overly sympathetic juries.

In the best of all possible worlds access to a public health system would bring the realization that there are no more excuses. We must each take responsibility for our health and realize that if we don’t make the lifestyle changes necessary to heal, we give up our right to complain or blame “the system” for leaving us behind or for not taking care of us. As we’ve seen with the current system, there’s only so much modern medicine can do at any price.

There, I’ve said it. Give it some thought and let me know what you think. In my opinion, without serious dialogue and outrageous ideas like this, our health will continue to deteriorate until we are a bankrupt, obese, diabetic, arthritic and Alzheimer’s-ridden nation with no good prospects for the future – and no good memories of the past.

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67 Comments on "Deconstructing Healthcare in America – a Modest Proposal"

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Brian
Brian
9 years 1 month ago
Your health proposal is definitely well thought out and comprehensives, and I agree with the spirit and the ideals behind it, but – and you knew there was a but coming – with our current political system there is no way this could work. Enter the special interest, the PAC’s, the lawyers, the pork spending politicians, and the social minded who would say you are an elitist because you propose 2 systems one for the “rich” and one for the “poor” – even though that is not what you said. If, you could cut through all that quagmire and get… Read more »
Oxybeles
Oxybeles
9 years 1 month ago

Nothing modest about this. Needs to be forwarded to all Presidential Candidates and President Bush.

I am contemplating a full response.

Mark
Mark
9 years 1 month ago

Thanks, Brian. That’s partly why I titled it “A Modest Proposal.” I agree that the likelihood of this ever happening is slim to none, but I wanted to fantasize and use an outrageous outline to underscore failings of the current system. I think the biggest glitch is the “government accountability” gap. That’s what’s missing in all our most heavily-funded programs. Second biggest is probably the lack of personal responsiblity that continues to permeate our society.

Nancy S
Nancy S
9 years 1 month ago
And how about some sort of reduction in the co-pay for those who maintain a healthy weight/BMI. It’d be hard to prove whether or not you exercise (my neighbor is very thin but she doesn’t exercise beyond chasing after her kids, much like me) but it’d be great if you could also “reward” good exercise and eating habits. That way those with the problems like smoking related illnesses and weight related illnesses would pay more of the burden for treatments of those diseases. I’m with Brian too, on the government not having a stellar record with running anything (I’m a… Read more »
Sara
9 years 1 month ago
Nancy, I love that idea! Your car insurance give a discount if you’re female, student, no cell phone, safe driver, etc. Why not do the same and reward those who are fit and lean? I agree it would be hard to prove, but certainly a gym membership or a few grocery receipts proving smart food choices could be ways to offer proof. I’m pretty sure the founding fathers would faint if they saw our system today. They wouldn’t even recognize it. Ben was against commerce, Madison surely would have been against lobbies and special interests, and Jefferson warned against a… Read more »
Brian
Brian
9 years 1 month ago

Nancy, I like your idea of the discount, but we can’t be using BMI… if they did I’d be scr — uhmm — “out of luck”. My BMI is 30.5 — AHH! I’m obese, but wait my last hydrostatic test said I was at 14% body fat???

I only gripe because my life insurance was using BMI and I had to get a physical and a visit from their nurse before they would give me a better “Healthy” rate…

John
John
9 years 1 month ago
The New Zealand health system is largely based around the proposal that you have outlined. It is far from perfect but anyone who needs healthcare is entitled and receives it. I don’t know of hand the per capita spend but I understand it is about one third of the US spend. All prescription drugs are purchased by a government agency at negotiated prices from drug companies who submit tenders. We have an Accident Compensation Corporation that workers and employers subscribe to. This pays the cost of treating accident victims and provides lump sum compensation for various injuries. It is based… Read more »
Donna
Donna
9 years 1 month ago

There’s also a shortage of Registered Nurses. Many work overtime and swing shifts and some even on call, esp. if a nurse works in surgery.

Crystal
Crystal
9 years 1 month ago
I belong to that large group of people w/o health insurance. I am not working right now and my husband was layed off a couple years ago. We had private insurance for awhile which is outrageous $$. Later I was denied any insurance….they looked into my history and found out I had thyroid surgery. They called me on the phone and rudely told me I was unhealthy. Sorry, no brownie points for living a healthy lifestyle. I like your proposal, Mark. I have found that I get better care when the doctor knows up front I am paying cash. Sometimes,… Read more »
Nancy S
Nancy S
9 years 1 month ago

Brian, don’t know much about BMI, just knew it was some sort of “standard” being used. I don’t even know what mine is. But I’m fine with using a different measure. I think so much of what people think of as “healthy” has to change.

RM
RM
9 years 1 month ago

I don’t agree with much of your positions, so that as background, but particularly #2 and #6 are not consistent. We need more doctors, so we institute a system paying doctors almost no money (compared to their equally educated peers) and imposing an onerous 8 year servitude to the government?

Deb
9 years 1 month ago

That’s a heck of an article. While some I agree with, and some I don’t…I respect that you wrote it all out, and gave so much thought to it. What we do know is it’s time to fix the problem…..and we need to start looking at preventative health instead of waiting until people are broken.

Oxybeles
Oxybeles
9 years 1 month ago
After much thought and consideration, I offer my $.02 worth: 1. While one can argue that the US Constitution guarantees certain inalienable rights, i.e., Life, Liberty and the Pursuit of Happiness; it does not specify the quality of the life. Hence, free medical coverage appears to be a stretch. 2. To establish a Government bureaucracy for medical care both administratively for coverage, let alone as a quasi-employer of thousands of medical professionals would be costly and inefficient. While a military is needed, one successful example is the US Post Office. It has only taken over 200 years to get it… Read more »
Ben
Ben
9 years 1 month ago
Not sure that emulating the two tier retirement savings program we have is all that good of an idea. Let’s see, we have the private tier, 401ks, and everyone seems happy with that. Then the public tier, social security, which creates unending complaint and is likely to send this country into bankruptcy since it was designed for a faster growing, quicker to die population. Also, you cannot say the free market system has been tried and failed. There is nothing free market about the current system. There are so many government regulations that barriers to entry to all parts of… Read more »
Ben
Ben
9 years 1 month ago

Oh yeah, and don’t forget that every single other country in the world gets a HUGE discount on medical care because pharmas in the United States spend billions creating the drugs that the rest of the world then uses without having to worry about development costs. And a new drug, partially due to the influence of existing government regulation, costs billions and billions of dollars to design and walk through the over-onerous and mis-aimed FDA testing.

Mark
9 years 1 month ago
Ben et al., all good points. I think the one that resonates most with me is “barriers to entry.” If we had an FDA that worked properly and we could train docs quicker (much quicker and for much less money), a free market system would drive prices down. It would be interesting to observe. But at some point, we will always have a large number of people who can’t afford medical care at any price and the question will be “who pays for them?”. I am no fan of a welfare state – I think everyone should have to earn… Read more »
Mark
9 years 1 month ago

On another note – the BMI thing. I am 5’10” and 165 pounds and 8% body fat. My wife thinks I should gain a few more pounds. Oddly enough, if I gained 10 pounds I would drift across the BMI line into the land of “overweight” – even if it was all muscle!!

Needs Work
Needs Work
9 years 1 month ago
Your proposal reads nice on the surface but manifests many serious flaws. One of the largest problems is the degree to which you discount the knowledge and training of doctors and FNPs. While many functions currently performed by MDs could be broken out into other vocations, many couldn’t or shouldn’t. Another major problem is that the majority of the specifics of your program must be determined by committee. History has shown us that that government committees are usually tainted by private interests and crippled by cost structures. Given the huge amount of capital infrastructure associated with hospitals, there is a… Read more »
Sara
9 years 1 month ago

It’ll be interesting to see how Massachusetts’ system goes.

Doug
Doug
9 years 1 month ago
Realize that the ‘free market’ is a theoretical construct, which has never been seen in the wild. Health care in particular cannot ever reach even a first approximation of a free market, since the supply and demand curves are not simply determined by price. Free markets in their pure theoretical Platonic form produce efficiency, not equity. It’s necessary to remind the free marketeers that we live in a society, not just an economy. It may be efficient to let poor children die for want of medical care, but it’s not usually considered rational or humane. For experiments with free markets… Read more »
Sid Schwab
9 years 1 month ago
Much of what you say is worth attention — in fact lots of it is out there already. Couple of things: first, doctors don’t “charge” any more. What they get is decided by insurers and governments. There are virtually no doctors nowadays that decide what to charge, charge it, and get it. I can say my fee for, say, a colon resection is any number I want to pull out of the air. What I get is exactly what the insurer pays, no more, no less. And, in general, it’s considerably less than what’s written down somewhere as my fee.… Read more »
Donna
Donna
9 years 1 month ago

My Husband Is 5’10”,So Am I, He Weighs 162 lbs. And I Don’t! He’s A 33 Waist. My Opinion-I’m always encouraging him not to gain not a pound.
He does agree. 9 years ago i taught him to eat right, exercise, and he lost 60 pounds in one year. I told him to lose weight over a period of time, slowly, not fast.

McFly
McFly
9 years 1 month ago
Mark, You titled your piece A Modest Proposal. Well here’s my modest proposal: One out of six babies is born with a birth defect. This includes everything from slight hearing loss, to severe brain damage. One out of 6 babies adds up to roughly 150 million people living today with genetic defects. These people are the ones most likely to tax the health care system with the largest hospital bills and they are also the most likely to produce offspring with birth defects. I modestly propose we recycle the 17% of babies born with genetic defects. We will perform En… Read more »
CKB
CKB
7 years 1 month ago

I think I just threw up in my mouth.

dot
dot
5 years 3 months ago

I suggest that we “Swiftly” implement this proposal

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[…] read Mark’s provocative proposal for overhauling the health system, be sure to catch it here. And this just in from the New York Times. Is less more? Is more […]

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[…] you and hopes you get obesity and diabetes really soon so you can take advantage of all the great medical care that we don’t […]

Shirley
Shirley
9 years 1 month ago

Your health proposal sounds like a winner, something has to be done. Americas toxic food supply is making our children obese and causing all sorts of illnesses also. 2 years ago I took charge of my own health. I took on the paleo lifestyle, started exercising and using supplements. I lost 70 lbs. and feel 20 years younger and have lots of energy. I am now off all my medications. Proloftin lowered my blood pressure. Thank you Mark for doing a public service to us all. Shirley

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[…] painkiller addiction that’s unfortunate: those who truly need help are facing even more of a health care nightmare than the average person (as if that were […]

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[…] My Healthcare Proposal […]

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[…] One more note and I’ll turn the pulpit over to you: the L.A. Times has a piece out today that clarifies our national health care picture even further. Roughly 90 million Americans went at least part of the last two years without any coverage whatsoever. If you’re new to the blog, be sure to read my radical proposal for overhauling our health care system. […]

Dr.J
Dr.J
9 years 9 days ago

I like how everyone loves the ‘government pays for everything’ health care solution. Here’s my, everyone hates idea: Everyone PAYS for the care they get! Wow, you want time with your doctor, pay for the time and I bet you’ll get it. Free market health care. No health insurance. Everything will become a lot more affordable this way.

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[…] you’ve read Mark’s Deconstructing Healthcare in America: A Modest Proposal or one of our other healthcare rants you know Mark’s Daily Apple has a lot to say about […]

mark
mark
8 years 11 months ago
I recently read a free online book that has some good ideas on this and other economic matters. The books is called “The Conservative Nanny State” at http://www.conservativenannystate.com . Despite its name, I think it would be good for any concerned citizen to read. The author is an economist who has exposed how much of the economy in America is set up to benefit the few at the expense of the many, and that Republican, pro-business policies are anything but being “free market.” Note: I’m not in any way affiliated with the web site or the writer, and it can… Read more »
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[…] My thoughts on health care in America […]

USCBlogger
8 years 6 months ago

Beautifully written. I love works that are written in this way to get a point across. I was extremely drawn in and feel very informed about the topic. After reading Swift’s A Modest Proposal, I began trying to write some too. I want to start a blog and would be honored if you would read what I have and let me know what you think. http://mymodestproposal.blogspot.com

Thanks again for the great content. I plan on joining your readers list!

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[…] Deconstructing Healthcare in America – A Modest Proposal […]

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[…] Deconstructing Healthcare in America- A Modest Proposal […]

Strong One
8 years 3 months ago

Now.. I’m a tad bit dissapointed you NEVER gave mention to the effect of the nursing shortage on healthcare.
hhmmm..

Paul Hsieh
7 years 10 months ago

I’d like to urge caution about accepting at face value the studies that claim that the US health system ranks 37th in the world.

There are some serious methodological problems, as discussed here:

http://www.westandfirm.org/blog/2007/08/misleading-rankings.html

For a more detailed discussion of problems with “universal health care” as well as some viable free market alternatives, see:

“Moral Health Care vs. ‘Universal Health Care'”

http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp

Paul Hsieh, MD
Co-founder, Freedom and Individual Rights in Medicine (FIRM)
http://www.WeStandFIRM.org

trackback

[…] always have access to ideal foods. We shower too much in water that’s too hot. We use medicines to mask our symptoms instead of allowing our bodies to deal directly with the problem. You get my point. It’s […]

Jon R
Jon R
7 years 9 months ago
Good article and several good posts picking at the particulars. I have been involved in cancer research, medical education and the drug industry for the past 11 years. The following summation is based upon that knowledge and is organized based on the fields mentioned in the article. 1-(Patient Responsibility): Yes, patients do need to do their homework and there is evidence to support this theory. In my experience Americans are the most educated/informed and vocal in the world. This trend causes practices/doctors to be well educated and order additional tests thus increasing expenditures. 2-(Not enough Docs): True, but you can… Read more »
Tara
7 years 8 months ago

This is a fantasic post! I agree with about 90% of what was said. As a future doc, I am a little scared myself, but have to assume that change is coming. This, or free market, is THE way to go.

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7 years 4 months ago

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[…] Deconstructing Healthcare in America – A Modest Proposal […]

Dr. Hamilton
Dr. Hamilton
7 years 3 months ago
You make vaild points. I even agree with many of them. I do take exception with some however. 1)Shorter Training times for doctors. I feel you are wrong here. One of my attendings once said that he could teach a monkey to do surgery. This is true. The problem is not the mechanics but everything leading up to and after the surgery. Sure I could order an MRI and determine that a tendon is ruptured, but what then… Which of the numerous procedures would be most appropriate for that patient. Following the surgery an infection develops (accepted rate in orthopedic… Read more »
Dr. Hamilton
Dr. Hamilton
7 years 3 months ago

I would end with a word of caution…

“A government big enough to give you everything you want
Is a government big enough to take away everything you have.”

Gerald Ford

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[…] to checking in. While this is certainly an extreme example, the reality is an over reliance on the modern healthcare system can be…well, deadly. In fact, the majority of people enter hospitals for ailments that could be […]

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[…] Deconstructing Healthcare in America – A Modest Proposal […]

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[…] been ranting about. Since October ‘06 we have covered everything from diabetes and the American healthcare system to fats, food, and fitness. View the Best Of and Most Popular Posts to reminisce, and check out […]

Suzanne
Suzanne
7 years 11 days ago
Go to Europe and try out the socialized health care there and come back and tell us about it. I’ve been and my relatives have been and we had to utilize it. Not something I would want to experience again. Health care is a right, free health care is not. People have no right to demand that professionals give them services for free. And if people want to stay out of doctor’s offices, then maybe they should take better care of themselves. And funny how those same people always manage to have money for a cell phone, television, computer, hair… Read more »
Welshcaveman
Welshcaveman
7 years 11 days ago
Being from the UK, I have always lived in a place where healthcare was “free”, in as much as you didn’t need to pay an insurer to cover you should you need treatment. As a result, it seems alien to me and others here that people would be against their government providing this facility. As a talk show host over here recently commented “Only in America can a President say he is going to make healthcare accessible to all… and then watch his popularity scores plummet”. Here we do sort of have a two-tiered approach. Everybody has access to the… Read more »
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