Health-Care Reform: The Government Run Public Option is Rooted in the Intellectual Laziness of Congress and the Administration

Consider the following syllogism:
(1) To ignore (or refuse to consider) alternative solutions to health-care reform* is intellectual laziness.
(2) Other than expanding the government’s role in health-care, (public option, Medicare for all), the US Congress and Administration ignore alternative solutions to health-care reform.
(3) The US Congress and the Administration are intellectually lazy when they fail to consider alternatives to their government expanding health-care reform proposals.
* or any other problem for that matter


What are the purported purposes of the government run public option (GoRPO)?
The administration and Congress are correct when they point out that, to reduce individual costs for health-care and to insure the uninsured, we must have competition among health insurance companies. You’ll get no argument there from me or just about anyone else on this. Many members of congress, with clandestine support from the administration, declare that the only way to achieve these goals is through the GoRPO. That is, the GoRPO with lower insurance premiums because there is no profit motive, will serve as the prime nationwide competitor to all private health insurance providers. What government run program is known for efficiency and cost containment? Having worked for the federal government for 27 years, I can attest to the inherent inefficiencies and wasteful monetary practices. Sure, it would be simple to add another entitlement program further bloating the federal budget with attendant cost escalation (more government run health-care will never be budget neutral; is Medicare?). To expand federal government involvement in our health-care system while ignoring not only failures of state run systems but also the efficacy of alternatives is nothing less than intellectual laziness. Moreover, the intended and unintended consequences have severe repercussions for the future US health-care and the very fabric of US society.


In addition to desiring to insure the uninsured and reduce costs of health-care, a key intended (though rarely discussed) consequence of the GoRPO is the progression to a single-payer (government managed) health-care system for Americans (this has been stated publicly as desirous by some members of Congress). How can this happen? At the present time, the federal government manages or provides insurance for 33% of the US population. It would only be a matter of time, through GoRPO mission creep, that the government will be responsible for over 50% of US citizens. With this majority stake, the federal government will have the power to dictate rates and services for most Americans, effectively controlling all aspects of US health-care.


The unintended consequences of a GoRPO are numerous and include, but not limited to: cost overruns (as example – the government program Medicare will be bankrupt by 2017; the Massachusetts program is $9billion in debt), rationing (the only way to reduce escalating costs), higher taxes (income tax rates in western European countries range from 40% to 60% for the middle class), fewer new drug and device developments (from a decline in medical research and development – the government will be unwilling to pay for costly new products; e.g. the U.K. refuses to offer certain effective anti-cancer drugs because of cost), reduced citizen productivity (from loss of work while awaiting procedures), slowed or arrested progress in medical advances (e.g. fewer clinical trials testing new drugs or devices), dissolution of the private insurance industry, demise of private medical practices (all health-care providers will essentially be de facto government employees), government will be forced to pay for all medical education as is done in western Europe because individuals will no longer be able to repay loans for their medical education (the President seemed astonished this past summer when a Georgetown University medical student informed him that her debt after graduation will be $300,000), reduced quality of individuals seeking to enter medicine (in the UK for example, many physicians refuse to works nights and weekends), more claim denials (Medicare already denies a higher percentage of claims than any private insurer) and destruction of the medical profession as we know it.


Are there non-governmental alternatives to the GoRPO? Sure there are. We can insure those without access to insurance (6 to 14 million people by most reasonable estimates) by creating a privately managed member-owned pool consisting of the 6 to 14 million combined with employees of small businesses. Furthermore, such a large pool will have substantial clout in negotiating rates with insurance companies, thereby lowering costs. Another way to reduce cost is to allow companies and individuals to select insurance across state lines as is done for auto insurance. This approach will provide the needed competition and reduce health insurance costs. Proof that this is effective already exists. The 9 million participants of the Federal Employees Health Benefits Program have over 250 options from which to select and have enjoyed a lower rate of rise in insurance premiums when compared to the industry as a whole. Lastly, tort reform is an essential ingredient to reduce costs in any health-care reform proposal and must be applied across the country; billions of dollars will be saved annually.

Government intrusion into the American way of life must be the absolute last resort for resolving the issue of health-care reform, not the first solution we consider. An April 1959 memo from the Department of Health, Education and Welfare to congress is germane today:
In our society the existence of a problem does not necessarily indicate that action by the Federal Government is desirable. The basic question is: Should the Federal Government at this time undertake a new program to help pay the costs of medical care…, or should it wait and see [first if other options are effective]?


How many Nobel Prize recipients in Physiology or Medicine have been from the US? Since 1950, 58%. With a single payer system, future advances may never see the light of day in clinical practice. What nation other than the US can boast being responsible for bringing significant new technologies and drugs from the bench (laboratory) to the bedside (clinic or hospital)? That other nation doesn’t exist. The US has the distinct and singular honor for the primary development of new medical technologies not only for the US but for the entire human population.


The administration and congress have a mandate to establish health-care reform. But we want it done right, the first time. You know, sometimes neither the easy nor the get-it-done quick ways are the right paths. Don’t mess this up. Don’t be lazy.

This article may be downloaded from my website:
thomasreid3md/home/health-care-reform

Health-Care Reform: Progression From a Government Run Public Option to a Universal Single Payer Health-Care System–By the Numbers (US Population)

Health-Care Reform: Progression From a Government Run Public Option to a Universal Single Payer Health-Care System – By the Numbers (Analysis of the US Population).*

What will be required for the federal government to take control of health-care in the US? A majority stake in US health-care is the answer. The proposed government run public option (GoRPO) is the first step in the process. This is the only possible conclusion upon analysis of health insurance data later combined with the GoRPO.

The US Census Bureau considers four major categories for Americans with health insurance: Medicare, Medicaid (includes the State Children’s Health Insurance Program; SCHIP), employment based (private) health insurance (includes the Federal Employee Health Benefits Program [FEHBP] and Tricare [covers active duty personnel, retirees and their dependants]) and self-pay. In addition to Medicare and Medicaid, the federal government is also responsible for insuring veterans (VHA) and Native Americans (IHA). Insurance data from the US Census Bureau show that 111 million Americans have their health-care insured and managed by the federal government (Medicare, Medicaid, VHA, IHA), about 33% (see Figure 1). [Note: The US Census Bureau realizes that many individuals with Medicare also have other insurance, but such data are not available).

Though not managed directly by the federal government, the health insurance coverage for Tricare beneficiaries and participants in the FEHBP (approximately 9 million Americans in each of these groups for a total of 18 million insured) is actually paid for by the federal government. Since the government is responsible for paying the health insurance for these individuals, the federal government in effect controls their health-care because the government negotiates with the entities to manage the health-care of those enrolled in either Tricare or the FEHBP. That is, the health-care of those enrolled in Tricare and the FEHP is de facto government run health-care. Rather than account for these 18 million individuals under the employer based (private) health insurance category, it would be more appropriate to include them as a government program (along with Medicare, Medicaid, VHA and IHA). Consequently, this now brings the total number of Americans whose health-insurance is controlled by the federal government to 129 million, an increase to 38% (see Figure 2).

Regardless of the veracity of the number of uninsured considered to be 47 million by the administration and much of congress, we will use this number as it seems to prevail in many discussions and speeches. If we now insure the 47 million presently uninsured in the GoRPO, this brings the total number of Americans whose health-insurance is controlled by the federal government to 176 million, an increase to 46% (see Figure 3).

Now let’s suppose, not an unrealistic supposition at that, that about 10 million individuals (21% or approximately one-fifth) who pay for their own insurance (the self-pay category) realize they are eligible to participate in the GoRPO [a rather conservative estimate, actually]…. and they elect to participate. This now brings the total number of Americans whose health-insurance is controlled by the federal government to 186 million, an increase to 49% (see Figure 4).

Some have predicted, and I think correctly so, that many businesses will find it far less expensive to pay a fee to the federal government than to cover their employee’s health insurance. Let’s make a conservative estimate (guess, if you will) that of the 159 million presently receiving employer based insurance, 20 million (or about 13%) find themselves seeking and receiving health insurance through the GoRPO. This now brings the total number of Americans whose health-insurance is controlled by the federal government to 206 million, an increase to 54%; that is, more than half of the US population (see Figure 5).

With the government providing for the health insurance of over 50% of the population, it would be the major health-care stakeholder in the US. Such control would, without question, directly lead to (A) terms dictating how health-care is managed in the US, (B) [initially] a two tiered health-insurance system, and (C) [eventually] a single-payer universal health care system. That GoRPO is the first step leading us toward a single-payer universal health care system is appreciated by REP Anthony Weiner D-NY who supports such a health-care system for the US. Given the example of Medicare and in an effort to control costs, health-care rationing on a fiscal basis is only a matter of time. (See my essay titled: Health-Care Rationing - A Practical Construct).

*Abbreviations in Figures:
GoRPO – Government Run Public Option
FEHBP – Federal Employees Health Benefits Program
IHA – Indian Health Affairs
VHA – Veterans Health Administration

This article may be downloaded from my website:
thomasreid3md/home/health-care-reform

Health-Care Rationing - A Practical Construct

The concept of health-care rationing has not been adequately discussed in public because it’s a touchy subject, appropriately so. But a discussion of health-care rationing and treatment delays is imperative as these are serious long-term consequences of government run public and single-payer options. On a recent news program, Secretary Sebelius has indicated that rationing goes on all the time. Yes and no; i.e. not all forms of rationing are equivalent.

First of all, rationing must not be confused with good medicine. A physician’s decision not to order a test or perform a procedure not indicated for a patient’s symptoms or disease is not rationing; rather, it’s just good medicine. We can distinguish three types of health-care rationing: natural, self and fiscal. Natural rationing is a consequence of a limited biologic resource. An example would be limitations in the number of hearts available for heart transplants. Bottom line, not everyone who needs a heart gets one. Self rationing is when a patient’s clinical situation precludes interventional therapies. For example, an individual with a broken hip and advanced cancer of the pancreas with less than two months to live would not receive a hip replacement. Physicians make these decisions all the time. It is most disappointing, to say the least, to hear talking heads and politicians (who, by the way, know little to nothing of medicine) suggest that doctors are not doing this. Furthermore, no one would dispute this form of rationing. Lastly, fiscal rationing is the limiting of health-care because of arbitrary financial constraints; e.g. where an indicated treatment (surgery, chemotherapy etc) that will improve survival and/or quality of life is not provided because of arbitrary measures (generally fiscal, but others such as age would be considered) and/or inherent delays (e.g. insufficient number of physicians). It is this type of rationing that is not standardly practiced in the U.S. and scares Americans.

This article may be downloaded from my website:
thomasreid3md/home/health-care-reform