Medical Care: A Modest Proposal

We have heard a great deal of talk about how we should nationalize health care in order to make sure that everyone will at least get something. This seems to me to be a lot like rationing an available resource so that everyone will get at least something. This also seems to me to be an inadequate answer to the problem. It's something a Harvard MBA would come up with, and you know what that means: having someone divvy up the pie rather than trying to come up with new ways of baking more pies. That trick seems to have resulted in just about every American business going under.

Other methods seem to be in order. I suggest at least three.

1. Make Medical Education More Available.

In most civilized countries, doctors and nurses go through a specialized training in college, somewhere between four and six years. At the end of that period of study, they go through a residency of between one and three years in their specialization. Then they practice medicine.

In the United States, first they go through four years of college. Then they go through four years of medical or nursing school. Then they go through a residency program that can last between three and eight years. THEN they practice medicine.

So let me see: you can spend between five and nine years of study to become a doctor or a nurse in Europe, or eleven to sixteen years of study to become a doctor or nurse in the United States. Do you think that there may be a causal connection between the number of years required to become a health professional and the costs of their services? I certainly do.

Of course, you won't see any such change, because any such change would have to be approved by the American Medical Association, and they have an interest in keeping the number of physicians down in this country. You know, monopolies, a limited resource keeping prices for that resource up, that sort of thing. I do not think it a coincidence that the AMA pays more for Congressional lobbyists than anyone except for the pharmaceutical companies. Pity.

2. Make more effective regulations of pharmaceutical prices

Anyone who has gone to any other country besides the United States for any length of time knows that it costs far less to buy drugs there than it does in the United States. This is because most civilized countries, with the notable exception of the U.S., have regulations preventing pharmaceutical companies from charging whatever they wish for their drugs.

Shriek! Why, no Bernie: I thought you were a laissez-faire capitalist. I thought you were against any regulation of prices. How can this be?

Well, I used to be, but then a good number of years ago I saw an episode of the PBS science series, Nova. It was a review of what had been learned about the use of L-Dopamine in the treatment of Parkinson's Disease. In that episode, it showed a researcher spooning out a gram or two of the drug from what was a one kilogram jar. The researcher commented that he was glad that he had purchased the jar back before he and his team had reported the findings concerning L-Dopamine's effects in the New England Journal of Medicine. Before the report, one kilogram cost him $50.00. After the report, the pharmaceutical companies raised the price so that the same amount of the drug would have cost him $17,500.00.

In short, just upon finding that a drug in their control might have some effect upon Parkinson's Disease, the pharmaceutical company in question raised the price of a drug more than three hundred times its original price. In looking at many other drugs sold in the U.S., it would appear that similar price differentials between cost of production and sales price obtain.

I don't know about you, but when one sees price gouging of such range and magnitude, and in an industry which produces goods which are essential to the public and private health, it drives even the most ardent capitalist to thoughts of regulation, if not nationalization.

Of course, it would take Congressional legislation to regulate prices for pharmaceutical companies. And it seems that those companies pay just as much to and for lobbyists, if not more, than the AMA does to keep things just as they are. Again, pity.

3. Convert all medical malpractice cases from judicial trial to arbitration

One of the reasons why physicians, nurses, and other medical care personnel are getting to be more and more unwilling to practice is the real likelihood of being faced with a malpractice suit. Such suits have driven up the prices of malpractice insurance premiums to the point that physicians are starting to pay more in premiums than they do in taxes. This reduces the number of physicians in the U.S. who are willing to practice medicine, which in turn drives up the price of medical care. You can probably see where this one is going.

Many of those suits are spurious, brought by patients who have unrealistic expectations as to what modern medical care can actually do for them. They get dissatisfied with the care given them, and they bring lawsuits in state courts. The lawsuits in turn go through an elaborate process of pretrial motions, discovery, and preparation for trial. Most of those cases settle, but only after an elaborate expense has been made by and for the attorneys.

As regards the rest of the cases which DO go to trial, the factual matters of the trial, often matters of great expertise, are decided by twelve men and women who have been elaborately selected NOT to have any expertise in these matters of fact. The joke among lawyers is that a jury is a creature with twelve heads, twenty four legs, and no brain. Largely, in most trial cases, whether a patient or a physician prevails depends on who has the most persuasive attorney.

Of course, there is a simple remedy to this problem, which is Arbitration. What happens in such cases is that the patient files a simple process in which he or she explains what is the matter. Often, an independent physician is hired to examine the patient, and to examine the medical record of the patient. These findings are presented before a board of three or more arbitrators who have expertise in the medical field involved, and can quickly determine which cases are spurious, and which are valid. The whole process takes a fraction of the time, money, and trouble that a court case would require.

Of course, don't expect to see any congressional legislation requiring medical malpractice cases to be submitted to arbitration. The reason for this is that the American Bar Association, American Trial Lawyers' Association, and insurance companies pay nearly as much money to Congressional lobbyists as the AMA and the pharmaaceutical companies. It is not in the financial interest of these august associations to let that happen.

In short, as the late Will Rogers said, if the opposite of 'pro' is 'con', then the opposite of 'Progress' is 'Congress'. As long as Congress continues to permit the legalized system of bribery that we so endearingly call 'lobbying', we will continue to have high priced health care.