The solution must be determined by facts and not ideology. Ideology has a miserable way of failing. All we have to look at is the failure of an ideology that occupied the attention of the world for nearly the entire 20th century. The collapse of communism surely showed that economics dictated by ideology is doomed to failure.

The facts are clear. The healthcare industry represents one sixth of our economy. That is what 15% of the GDP means. It is bigger any other economic sector. The problem is that it is not an engine, but a brake upon the economy. Its size alone makes it imperative that we address it in an effective manner.

One third of the healthcare dollar is spent on administrative costs. These are costs that do not contribute to the delivery of healthcare. These costs are not to healthcare providers that actually deliver care, but rather to ancillary persons and institutions that do not provide one jot of healthcare. Administrative costs and those that benefit from them can only be seen as parasitic to healthcare delivery and to the economy.

Insurance companies retain up to a quarter of the healthcare premium. That is the overhead we pay for a system that we no longer have the luxury to afford. Compare that with Medicare’s overhead of four percent.

Pharmaceutical companies charge Americans twice as much as they do the rest of the world under he guise to fund research and development (R&D) of new drugs. Yet the facts show their profit margins are twice the outlay for R&D.

A tort liability system out of control has created a culture of fear in the medical community that drives 8% of the healthcare dollar into defensive medicine. Unscrupulous expert witnesses who sell their opinions to the highest bidder are used by unscrupulous trial lawyers to spin the roulette wheel of malpractice liability. While few actually hit the jackpot, the fear engendered by this dishonest behavior costs us, according to the DHHS in 2002, up to $120 billion per year.

The same hysteria that we see surrounding the healthcare debate today is merely a reenactment of 1964 when Medicare was passed. It is now one of the most popular programs sponsored by the government and is the ultimate “public option”.

The answer is clear. Insurance companies, the middlemen who, instead of providing care, are in the business of denying care need to be removed from the picture. Drug companies need to be treated in the same fashion as is done by the VA. Ask any veteran about their drug costs and you’ll be shocked by how inexpensive drugs are when bought through the VA. Real tort reform needs to be enacted by redefining malpractice as gross negligence.

By spreading the risk for healthcare over the entire population and every economic sector, we can cover everyone and reduce costs without sacrificing quality. There is such low hanging fruit to pick, we can save nearly a third of the healthcare dollar without sacrificing quality and access.

Those that oppose a rational solution are doing it out of political expediency. South Carolina’s Senator Jim DeMint’s contention that healthcare will be the President’s Waterloo and will “break him” is emblematic of the political opportunism rampant in so many of our leaders. Instead of courageously leading the way, many of our political leaders, including every candidate chosen for us in the 23rd district, pander to the lowest common denominator of fear. Not one will support a public program much less doing away with insurance companies. It is so much easier to engender fear than to lead with logic and fact. All that is needed are a few anecdotes of worse case scenarios. These are not leaders looking for a solution, but rather raw political opportunity and providing a spectacle of political bloodshed for the entertainment of an otherwise, albeit for good reason, cynical electorate.

In 1964, Medicare was roundly condemned as “socialized medicine” and within months of its passage became the most popular public program with both patients and providers. It’s time to expand it to include everyone.

True good to be true. By creating an efficient national health insurance system, negotiating with drug companies and reforming our liability laws we save a third of the healthcare dollar, nearly five hundred billion dollars a year. five trillion over ten years. If you’re flushing billions – no, trillions – down the toilet: stop flushing.

Bob Johnson, MD

Sackets Harbor