Everyone agrees that each year medical care costs more and more in the United States; and certainly more than in other societies on our orb. Cost is one of the reasons that not everyone is covered in the United States. Young healthy people duck the premium cost unless it is part of their employment contract. Others cannot afford it. In addition, our health care system does not result in better health care results than achieved in other countries such as those in the European Union, where health care costs are less. Even so, I have noticed that more and more people are living longer than they did in previous generations: 80s and 90s are no longer unusual. We have the ability to achieve healthier lives through immunizations, antibiotics, drug and radiation treatments for malignant diseases; and we have serious studies under way to affect genetic causes of disease such as type I diabetes. Genetic engineering is a key to conquering those diseases. Of course we also have the problem of self-inflicted diseases brought on by smoking and obesity with type II diabetes. So when the present administration stated that its first serious goal was health care reform, many agreed and looked forward hopefully.

I was one of those expectants and hoped that the administration, in concert with the Congress, would establish a Health Commission composed of nonpolitical people who had experience in law, sociology, ethics and the science of medicine. But I was wrong. The party in charge of both houses of Congress leaped into the fray and without help from the Executive Branch, took off in a most partisan fashion and drafted bills that served the party’s interests and regardless of their denials would add to our burgeoning social costs over the next 20 years. This is right at the time when the Baby Boomers are retiring. Existing programs that society depends on (Social Security, Medicare and Medicaid) are ready to fall off the cliff because the work force funding them has shrunk to a point that there no longer will be sufficient taxed income to support those social programs. In addition, over the years, Congress has spent from the surpluses being amassed for future funding of these programs, on other “deemed important adventures.” This approaching catastrophe has been apparent for the past several decades and there have been platitudinous responses that have been essentially delay-delay-delay. So here we are, ready to add another social program with insufficient funding. How can we look our grandchildren in the eye with heads held high? We can’t!

Why are medical costs continually rising? There are multiple reasons.

  • It is well known that medical services (hospitals and clinics) make up for losses on Medicare or Medicaid patients or treating patients with no insurance, by increasing their charges to private insurance groups. If they did not, the medical facilities would go under. Here in the Midcoast, private insurance is charged approximately 135 percent more than the actual cost for patient treatment to make up for losses from government sponsored programs. This factor is one of the reasons that private insurance groups are increasing their fees. To listen to the federal government, it is greed that is the motivating force. Private insurance is just that: private insurance. For-profit companies develop the policies. The citizens depend upon competition between multiple companies to contain the size of the profits. A good reason for open markets across state lines. (Reason for a Health Commission!)
  • Many of our medical costs have increased over the past several decades because of the development of the ability to image carefully and precisely. Before, there were only X-rays and barium or intravenous contrast studies using developed film to “peer inside.” If a result was needed urgently, a wet-reading was performed: the film was developed but not dried before the reading was made. There were increased errors in interpretation that were corrected when the final dry reading was made. Today, most of the imaging performed uses technologies available only in the past 20 to 30 years, such as ultrasound, magnetic resonance imaging and PET scans. These are much more precise than simple X-rays; and in these days of televised solicitations from law firms offering to represent you if there has been potential for a malpractice award, many physicians will resort to the most current imaging available to protect themselves from future “assaults.” It is the rare physician who knowingly commits malpractice. (Reason for a Health Commission!) I remain in awe concerning the president of the University of Cincinnati’s commencement address to our graduating senior class in the College of Medicine when he said, “The people who will have the greatest effect on your lives are also graduating this week: the seniors in the University of Cincinnati’s College of Law.” How cogent were his thoughts.
  • As medical knowledge and technological innovations have increased, there is greater stimulus for people interested in a medical career to pursue one of those branches. Interest in primary care has consequently diminished. Yes, it is true that many specialists command higher fees for their services than do generalists. In addition, many graduating seniors from medical schools carry debts in the thousands of dollars. The hope is that most graduating medical students studied medicine because they wanted to be a force for good among their fellow citizens. They expected to earn a good living to support and educate their families. If they wanted to become wealthy, they would have selected a different field than medicine. Long hours and self-sacrifice are rewarded by patient gratitude. However, fewer and fewer students are selecting primary care for their practice goals. When we have a national health care program, we may have great difficulty in finding a sufficient number of physicians to act as primary care doctors. How should they be rewarded? (Reason for a Health Commission!)
  • How does a society affect citizens’ unhealthy behavior? There is tremendous peer pressure for teenagers to smoke. Everybody’s doin’ it! (In our day, the movie stars all smoked. How glamorous!) Much of life today does not involve exercise: computers, Internet, television, driving (instead of walking). What do our citizens do while pursuing those inactive activities? Eat. (Reason for a Health Commission!)

These are a few reasons that health care for the United States of America is too complex to be determined by our elected officials alone. The entire issue has been way too politicized and now is stated as the determining factor in the success of President Obama’s administration. It is not too late to alter direction and pursue a course of careful study by those who have experience and determination in such matters. If President Obama would adopt such an enlightened attitude and direction, a Health Commission, he would be rewarded by being respected as the great president for which he has potential.

Fingers crossed!

Tom Putnam is a retired pediatric surgeon who lives with his wife, Barbara, in Rockland. He serves on a variety of nonprofit boards, as well as municipal committees, and is a communicant of St. Peter’s Episcopal Church.