The universal health care proposals from Hillary Clinton and her current nemesis, Barack Obama have a decidedly big-government focus. I have ranted endlessly on the disaster that Medicare has become and the expansion of that disaster in the form of universal health care funded through tax dollars. People always spend less money when they are spending their own. In my practice pateints pay cash for the services we provide unless they are given a charitable "gift" because of special circumstances. I only see patients that are willing to spend their own money for treatment. That puts significant pressure on me to perform to the patient's satisfaction. The patient is in charge of the process and makes choices based on discussion of the merits and expense of each option. When I used to work in the emergency department there was never a discussion of payment except in the rarest of circumstances (mostly just venting about high prices). Both systems can be viable but the patient-centered approach will invariably provide greater satisfaction for all parties in the transaction.

One of the great fallacies about the push for single-payer national health insurance is the assumption that people will be healthier. Until everyone takes advantage of the simple health-giving and lifesaving resources of good food and regular physical activity we're heading for a financial disaster as well as a personal one. I've seen the statistics about the "uninsured" and remain unconvinced that universal taxpayer funded insurance will do anything to stem the tide of obesity, heart disease and cancer. In fact, I believe that "free health care" will dramatically increase consumption and absolutely result in rationing. At that point only government officials will have the latitude to receive what they need when they need it. Instaed, I propose adoption of health technologies that encourage better lifestyle choices through coaching and personalized wellness planning. Corporations throughout the world are benefitting by instituting wellness plans that incentivize good health outcomes and reduced usage of insurance. Less utilization is the goal - not more!

In a completely unsurprising development the bone enhancement drug, Fosamax, has been found to have a "fatal flaw" as soon as its patent expired. There is a consistency to this that should not be missed by anyone who is paying attention. While the drug was still covered by a patent (and able to provide a regular stream of high markup revenue for the manufacturer) all controversies regarding the medication were refuted by studies that revealed the prettier side of the problem. Now that there isn't any reason to defend the drug no one is going to spend the money to "put out the fires" that spring up when a negative study is published. Since Fosamax may cause fatal heart arrhythmias it's just best to switch to one of the drugs that's under patent so the cycle can repeat itself. Isn't it great having the FDA looking out for your best interest? Maybe we should let them run all of health care. Just kidding, maybe we should acknowledge that a government agency can't protect us as well as free speech and free flow of ideas from citizen to citizen. That's how our country was built and designed. Constitutional freedoms protect us better than the nanny government system ever could. That's why we need to fight for our rights before they're stripped away in the name of convenience or comfort.

A recent press release from the National Taxpayers Union sounded a clarion call to doctors and patients alike. "When it comes to the financial condition of Medicare, the caregiver
has as many ailments as the patients," NTU Vice President for Policy
and Communications Pete Sepp said. "Unless Congress takes decisive
steps, large and small, to control spending and empower consumers, the
nation's taxpayers will soon be suffering from huge burdens they cannot
carry." The upshot is empowerment of the consumer. Without returning much of the decision-making to the patient there will always be perverse incentives that drive the costs of healthcare through the roof. In our practice every visit starts with the simple question "What are we going to do today?" The question is not based on poor memory or confusion but an acknowledgement that the patient has got to be involved with their care to produce the best outcomes. Anything less leaves the one with the most to lose (the patient) out in the cold. Medicare is built on the premise that it's someone else's responsibility to pay the bulk of the bills for the choices of the program participants. That someone else is the taxpayer -you and me!