An Open Letter on Health Care Reform

Dear Senators Specter and Casey,

This is an urgent plea for you to reconsider your stance on the current health care legislation moving through both houses of Congress. I am a 26 year-old Aerospace Engineer employed by a small software company outside of Philadelphia; however I have been on overseas sales assignments in the UK and now Singapore for the past 3 years. Yes, America is still very capable of exporting our superior products to the nations of the world. It is a good feeling to know that my success brings capital into our country by means other than ballooning debt, but I digress.

I want to make it clear that I applaud the President’s intent to make Health Care an urgent issue, but I am mortified by the speed and scope of the legislation that this Congress is trying to rush through while there is still an overwhelming single-party majority.

Yes, our country is in a medical crisis. Americans spend more on health care than any other nation in the developed world with little to no resulting medical benefits.[1] In fact, here in Singapore, both men and women enjoy better quality of life and longer life expectancy than their counterparts in America while spending one-fifth that of the average American on health care costs.[2]

I would love to see a day when everyone is healthy and can receive equal and top-quality care, but some of the measures set out the proposed legislation will create far more damage than good. The goal of this legislation was intended to make health care affordable for everyone; reduce costs, reduce inefficiency, and promote access to more individuals. Unfortunately, those goals have been lost in the current plan.. While it does include some beneficial clauses to guarantee access, throwing billions of dollars at a system that already spends more than any other health care system in the world cannot be the answer to reducing costs and improving efficiency!

I will point out 3 simple measures that would help gain my support for your re-elections and the proposed health care legislation known as The Patient Protection and Affordable Care Act which I will henceforth refer to as “the bill.” I think “the bill” is an apt name considering the conservative Congressional Budget Office (CBO) estimates of nearly a trillion dollar price tag for the current 1,000+ page monstrosity. In any case, I plan to argue my request that you only support this bill if it includes the following 3 conditions:
Tort Reform
Focus on Individual Responsibility (health savings over public option)
Phased Approach

Let us start with the judicial realities of America today. You are about to guarantee care for millions of new patients using the world’s wealthiest treasury in a country where ambulance chasers and trial lawyers outnumber the number of doctors. Its true. According to the American Bar Association and American Medical Association, there are more practicing attorneys than practicing physicians in America. Can you imagine if there is suddenly a government-backed medical plan for millions of new patients under the current legal environment?

There are numerous accounts throughout the country of Doctors leaving because they cannot afford to practice due to the cost of malpractice insurance. My own father was once warned at an Illinois Hospital, that if he required surgery during his hospital stay, he would need to be air-lifted to another state where they still had practicing anesthesiologists. Our county no longer had any who could afford the insurance in the local judicial climate. They had all left. This was a middle-class suburb of St Louis, not some farm town in the middle of nowhere.

So my plea to you is simple. Whatever reform you institute, please include comprehensive Tort Reform. Limit the damages in non catastrophic cases. Senator Specter, your own website points out that you agree with this![3] Please make it part of this health care reform! The State of Missouri implemented simple reforms like this in 2005 and has since seen a $26 million reduction in state-wide malpractice premiums.[4]

Please do not pledge billions of dollars to new patients until you limit the damage that frivolous lawsuits could reap from this bill. Unless you include comprehensive Tort reform, you will do little more than incentivize additional numbers of crippling malpractice lawsuits that would have the backing of the US Treasury.

This brings me to my next point. I cannot comprehend how any health care bill could pass that does not put the primary responsibility of cost reduction on the individual. I think we can all agree that there is one skill shared across America: we are great consumers! I know you have friends that can smell a good deal, and yet we do not use these simple market practices when deciding our own medical care. Americans with high-level insurance do not behave in the medical world in the same way they do in every other market. If you’re covered, you do what the Doctor tells you. On the other hand, in Singapore, the patient is responsible for the first 20% of their costs through a mandatory health savings plan to which they and their employers must contribute. As a responsible share-holder in where this money gets spent, patients are more cost-conscious than their American counterparts. This has led to a competitive medical market where a doctor consultation only costs about $12 even without any insurance! That is a system where 80% of primary care is performed by private industry of high-quality, western-trained doctors!

A public option in America would have the opposite affect. It would provide medical coverage to people who are currently being frugal and allow them to relax their spending on medical costs. Any plan backed by the tax payers should focus on personal responsibility. Insurers know about this problem: people on big insurance plans don’t really watch what they spend!. When I was born, my parents where part of a very clever insurance scheme that would split any savings 50/50 with patients who reported erroneous charges on their bill. Let me give an example. During labor, my mother had a sore tailbone, so my father bought her a pillow to sit on at the gift shop. When they got the bill for my delivery, my parents noticed the Doctor had prescribed an orthopedic pillow which cost a thousand dollars, but my mom had been using the one from the gift shop! So they informed the insurance company who disputed the charge and saved $1000 on the cost of my birth. Later that month, the insurance company sent my parents $500. The company still saved themselves $500 with this scheme. Honestly, when insurance is fitting most of the bill, how closely do you look at all those line items? Unless incentives are put in place to make patients responsible for their own health costs, adding new demand to an over-crowded health care system will not reduce costs! Please reconsider the public option for an option like health savings plans that are based more on personal responsibilities than government handouts.

Finally, slow down. You are talking about an overhaul of one-fifth of our nation’s economy. If you really believe that some of these measures can have a positive effect, implement them slowly over time. Are you afraid we’ll not re-elect you if parts of these ideas fail? Well, then you should slow down and pick better ideas. If you implement easy things first such as Tort Reform or the removal of limits from all insurance companies, then you can measure the effects on the medical system over time. If you really feel like you have good ideas, find the ones with the most support and get them through. If you find that you are starting to drive down costs, then you can continue your plan to expand coverage in a way that is both morally and economically responsible. The CBO has already confirmed that Medicare and Medicaid are already on unsustainable paths and if unchanged will represent the single largest segment of federal spending in the next few decades.[5] The changes you make here will have ramifications for generations. Please proceed with caution.

Please don’t try to pull the wool over our eyes. The American public and the people of Pennsylvania have selected you in our republican form of government to represent our interests. However, if you pass the bill as it is now, you will be doing more harm to America than the good you seem to want so badly. We can comprehend the complexity of this issue, so please do not try to mislead us. It is your responsibility to sort this out, but we are happy to help guide you along the way.

Respectfully yours,
Adam Gorski


References:
1) http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
2) http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
3) http://specter.senate.gov/public/index.cfm?FuseAction=IssueStatements.View&Issue_id=bd531be8-7e9c-9af9-74ef-d3a53537ede0&CFID=24084935&CFTOKEN=69578610
4) http://www.ncpa.org/pdfs/111809_HCN_2.pdf
5) http://www.cbo.gov/doc.cfm?index=9925