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Will Nicholson, M.D Why I said 'no' to my employer's health plan
By Will Nicholson, M.D., Maplewood, Minn.
July 22, 2009
To understand his patients better, a young doctor drops his workplace health coverage. more >>

Carol Lieb, Riverwoods, IL
Shopping for health insurance
Dr. Nicholson hits on some key points and I hope you will follow up on him. Most lawmakers don't have a clue about how difficult it is to be accepted into a program and to know whether or not you will actually be covered, should illness strike.

Giving people a tax credit won't help those who need coverage and don't have it. And even for the healthy, well educated, and solvent, comparing medical coverage plans and deciding which is best is a daunting task. Sadly, many people don't even have a choice.

Anne Peiffer, Minneapolis
Health coverage and its reform is a discouraging topic
My family has good health coverage. We are the only family I know that has good health coverage. I see people who are hard workers, great neighbors, who cannot afford health coveragee due to a pre-existing condition, who do not have consistent health coverage because they are seasonal workers or there are frequent layoffs in their industry. I know many people who are looking for work who do not have health coverage.

It is unreasonable to assume that anyone can go to an emergency room and get the care they need. A friend recently ended up in the ER with leg pain. She was given pain pills and sent home to rest. The pain got worse. Her husband took her back to the ER and got a copy of the previous visit's report. There had been no x-ray. This visit they x-rayed her legs and found multiple stress fractures, some of which had been there at least since her previous visit. Her husband was outraged, "Why didn't you take an x-ray?" The office employee said, "We can only handle so many charity cases, we can't do everything for everyone." They had insurance, they had given the documentation to the ER staff, it didn't get into the file. So much for anyone being able to get care and the hospital just writes it off.

I agree that health care has to be independent of employment. Basic preventive care keeps more people healthy and medical costs down. Please don't refer to times when we didn't have health coverage and people paid as they went. A lot of people waited to go to the doctor because they couldn't afford the medical bill and the groceries. A lot of people died as a result. Funerals are far less expensive than good health care, but I don't want to rely on that as a public health policy.

And don't get into "the liberal" this or the anything-wing that. When one is hit in the face with a loved one or great friend or neighbor not getting needed care in a timely way it doesn't matter one bit who says what! We need to be able to get medical care; our system is not working; don't quibble.

Everett Flynn, Minneapolis
This facile experiment will be an utter failure
My take is this... this doctor should just talk to people. He should talk to his patients, to his siblings, friends, neighbors to find out what their experiences are like. He should conduct as broad a personal survey as he can to answer his questions about this issue. That's a far better approach than he's proposing. He's a young, probably pretty healthy guy, probably with substantial discretionary income. His personal experience as a consumer of health care will not be REMOTELY similar to that of his patients. So his experiment is a failure before he even gets started. If, after seven years training in the field, he thinks he needs to undertake this facile "walk a mile in my patients' moccasins" experiment in order to inform his opinions on the issue, well.... that might be an even bigger problem for the doctor on a personal level. He needs to remove himself from his isolation as a young, healthy, high-wage earner if he wants to find out what his patients must endure. Talking to people (or, more precisely, LISTENING to them) would be a much better approach. UNLESS, he happens to work at a non-profit clinic or somewhere, where he makes a wage under say 50k a year, and he happens to have a chronic illness or injury (say diabetes, or rheumatoid arthritis, or a herniated disk or something). In circumstances like that, his experiment might very well permit him to experience many of the same daunting challenges that his patients face every day in trying to navigate our health care system. In circumstances like that, he might have to consider whether he should pay COBRA or the rent, pay for prescriptions or groceries. He might have to consider whether he should forego health insurance altogether and just take the risk. That is what real people are going through in this country, in many cases whether or not they have the luxury of employer paid health insurance. But this guy bothers me because his little experiment will likely get him no closer to those real world choices than he is in his isolated status quo. He should just talk to people, rather than posture with this article.

David Landowne, Miami, FL
Wonderful plan. I wish you great success. Now if we could only get this to be a requirement for graduation from medical school. It's probably to much to ask of a senator, but it should also be a requirement for the people's representatives.

Douglas Eglen, Kokomo, IN
Federal health care plan debate
As a country we have come to the point where we recognize that our current health care ''system' is not affordable. First recognize health care is not coordinated, it is not organized, it is not systemic in any sense other that it is universal - rather, it is a cottage industry that has grown into a patchwork industry. Current debate about health care is focussed on the wrong thing. HMOs, managed care, insurance companies have tried unsuccessfully to 'manage the system' of delivery of services, but inherently the point of application is financial. In most cases it hasn't worked. So why does the proposed solution give the control to federal government and big insurance? It's just the last step in incremental patches. The politically chosen topic is access - is this really the issue, or is it just a political expedient to get votes from the receivers of a free gift. Patients are still being cared for through free care from ERs all across the country, hospitalizations written off, gratis office visits, so isn't it odd that such an uproar is about the percent uninsured and not the percent not receiving treatment. Or is the president's concern about the provider end of insurance? i.e. providers not receiving fair compensation ?.......I think not.

So, is the crisis really access to insurance? Second point - Insurance companies actions appear to be similar to a legalized Mafia. Everyone pays out of fear of that they will suffer a life catastrophe if they don't. Insurance companies and HMOS, etc have no medical training, don't qualify with examinations, don't have a license, don't examine the patient or take a history but certainly they practice medicine , yet hide behind a cloak of legally written fine contractual print that no patient understands . Really... nobody understands what insurance will cover, let alone even reads the policy. There is no consideration in the equation of health care expectations for cost. Patients have no idea what their third party (read complete stranger) is paying or what the service actually costs. what kind of consumer is that? - it is different from all other issues of consumerism and for millenia has been properly addressed on a personal level. Insurance has provided a disconnect between the provider and the patient. Third party payers have achieved a position where they are not only accepted but expected. Consider history - this country had essentially no health insurance industry before the last 60 years. Specifically, current expectations have risen so that Americans want an MRI for headache evaluation and cardiac catheterization for chest pain, a full diagnostic workup for all patients regardless of their age or potential for recovery. Now some of us are equating it with a constitutional right. Does the US Constitution grant the right to property, the pursuit of happiness and health insurance? (This commentary was edited for length)

Sonny Corbi, Swannanoa, NC
Invest in Health Care
Speaking with my father one day as a younger man i was expressing some of my concept on education and financial matters and there importance. My POP was a person of few words, he turned to me and said, "SONNY THE MOST IMPORTANT THING IN LIFE IS YOUR HEALTH!". Do we really need a "Middle Man", should we be making a profit at the dimize of the afflected? Should our health care providers have to take on this massive debt so they can spend the rest of their life tending to the demize of the afflected? Concerning this HEALTH CARE bill can we not implament moniter and modify as we go? I wonder how many people would buy a MEDICAL BOND, $5.00, $10.00, $25.00, $1,000,000. This is our problem folks not the Presidents!

Greg Marsten, Luck, WI
Want to increase pay? Get employers out of Health Care
Just three years ago I was working as a news director at a small, rural Wisconsin radio station (without any real benefits or insurance) when a large Fargo-based network purchased the whole operation. Immediately, they touted their fantastic benefits, such as health insurance. The first act of ownership by the group (Red Rock) - after a dress code, mind you - was to reduce every employee's wages by approximately one-quarter. That was never mentioned before they bought the station. But they were "providing benefits," was the justification. They had "retirement," "life insurance" and health care. (The "life insurance" was essentially a flat-$10,000 "funeral policy!") I had the option to go under my wife's work "umbrella" health plan - since I already had for years - and asked to opt out of the Red Rock plan, with an expected pay adjustment/increase, since I would be saving them money. It was treated like a joke. Their corporate office people almost laughed when I asked about that possibility. Apparently, no one had ever brought up the scenario, or dared to even check. The pay reduction amounted to nearly $10,000, and their health plan was woefully inadequate, with a high deductible, even for a relatively healthy person like me. I know they were spending just a fraction of my "pay savings" on this plan, since they had so many employees, and I also know they were receiving some lucrative corporate tax benefits by "providing" health care. I have yet to hear anyone even mention that some employers or big businesses use health insurance/care as a potential money-making "justification" for lower pay scales, but it happens and I was a victim.

I no longer work for the group - actually nobody who worked their at the time is still an employee. Get employers out of the picture! I really see no connection in the modern system or world. In the old days, when health care was more affordable, it may have been used as a tool to keep quality people. Now, many shrewd business-types may be abusing the expectation, and may use it as a way to reduce pay scales and labor costs, and "look like" they are providing benefits and give a damn. It happens, probably more than we dare admit, and I was the proof. The irony? As a "money saving move" last year, I was fired, along with several other staffers. I was let go on a Friday morning, and when I got home, in my mailbox from that morning was a "bill" from the Red Rock group for the next months "Cobra" health policy! They had mailed the Cobra bill several days prior to my firing, and continued to send "bills" for a plan I never used or requested. Their true colors were quite obvious. BTW - I doubt anyone has worked for that group long enough to collect their "retirement benefits!" Thanks for listening.

Fred Hutchins, Cordova, TN
The Reality Of Healthcare And Health Insurance
Dr. Nicholson, Congratulations and more importantly, that you have chosen family medicine as your new career. I can attest to the fact that the mangled intersection of providing healthcare and the issue of health insurance today are both cloudy and continued bankruptcy if not addressed immediately. While I won't go into a long dissertation concerning facts and my opinions, these issues are multi-pronged including the obvious physical aspect of good health, emotion and economics. I would like to make one comment that I feel is of utmost importance. Healthcare, including lifestyle and prevention as well as the burgeoning costs, must be addressed and taught beginning in grade school through high school. Individuals can only be empowered through education and beginning at an early age. Given the educational resources, their decisions in life can and will improve concerning their health. Sincerely, Fred C. Hutchins Former Paramedic, Wake County Emergency Medical Services, Raleigh, North Carolina Former Long Term Care Insurance Underwriter, Banker's Life & Casualty Company, Chicago, Illinois Former Individual Health Underwriter / Processor, BCBS of North Carolina

Greg Gramig, St. Louis, MO
I offer my experience from a child with TGA, Heart Transplant
Will, Please feel free to reach out to me. I have nearly 17 years experience as an empowered healthcare consumer with experience in all three healthcare worlds, see children can also be covered under medicaid. I must say that in nearly all the most costly procedures, they came up suddenly and required immediate response as these were life threatening events. In another, the insurance company suddenly indicated that there was no coverage for a pediatric heart transplant in Georgia and we would have to have the procedure done in Birmingham, Alabama, a hospital four hours away. Also, at that time, the Birmingham pediatric hospital had less than desirable outcomes in cardiac transplant cases. These are just the tip of the iceberg in my experiences in many of the corners of the healthcare boxing ring. Sincerely, Greg Gramig

Mike Ripley, Fort Wayne, IN
Appreciative but concerned
Mr. Nicholson, I appreciate your quest to understand the individual consumer of health care and health insurance. Everyone who consumes or provides health care should be intent on learning everything they can about individual behavior. I am, however, concerned with a few of your comments. You say, "I hope to assume the role of the fabled empowered health care consumer. One of the most persistent theories in American health policy is that the key to excellent, affordable health care is for consumers to make shrewd purchasing decisions when it comes to health insurance. Physicians treat people as patients, not as consumers, so it is an unfamiliar idea to most of us", which clearly indicates that you do not consider the consumer as a strong actor in this arena. If a doctor treats a person as a patient and not as a consumer, why do some doctors ask for higher reimbursement rates? Why do some doctors refuse to join networks where an insurance company has negotiated a rate for the care that patients receive? Is it not because it cuts into their pay? While I feel that doctors receive fair compensation for the work that they do, if the patient's health is the most important focus, why do some hospitals not accept people on Medicare or Medicaid? I believe that some people forget that Medicare and Medicaid are in fact a type of medical insurance. People pay premiums, they have co-insurance, and they can only see certain doctors. Why then, have we not targeted doctors that charge exorbitant fees, doctors that unbundle services in order to make extra money off of simple procedures, or provide superior care to those who can pay and leave less time and attention for those who cannot? Is that treating a person as a patient or a paycheck? As for individual insurance compared with employer provided insurance, I believe there are two reasons that employer provided insurance serves many people well.

The first is this, the law of large numbers is the principle on which all insurance operates. Simply stated, the cost of taking a risk goes down with each additional insured. When you apply this principle to health insurance many lives are required to drop the cost of a given risk, and in turn drop premium. So in order for an insurance company to write a policy for an individual, they must cover the possible risks that an individual carries (hypertension, diabetes, great health, etc). It is more difficult to properly anticipate health problems in an individual than in a group. For this reason, employer groups made sense a long time ago, and continue to make sense today.

The second reason that employer groups make sense is because employers are an easily identifiable group of people, and therefore can serve as the channel for creating the larger numbers necessary to spread risk. With the above two points in mind, it becomes difficult to picture how individuals should fare well in purchasing insurance alone. If I am a high risk for heart attack, and an insurance company recognizes this, how can they legitimately only charge me $100 a month when I could potentially cost $50,000 this year for a by-pass? The insurance company would then have become a charity and soon after, bankrupt. To cover this risk, an insurance company investigates my health, and ideally charges a premium to match the risk that they take. At this point some would argue that this is why the government should step-in and provide a plan for those who cannot get group coverage, for whom individual coverage is too expensive, or have other issues obtaining health insurance.

What if the government trained doctors, surgeons, and nurses and provided its own healthcare and hospitals (apart from the VA)? According to the argument that a government plan would keep private insurers honest, the government healthcare would only keep private doctors, surgeons, and nurses honest and doing their best work. This outcome, however, is improbable at best. The government would become a monopsony, the only legitimate purchaser, of medical goods, and would leave private health care providers unable to bear the cost of purchasing on such small levels. Just as public health plans would lessen the large numbers of consumers that private health insurance companies use to underwrite risk. With all of this in mind, it is important to understand that in no way is it right for insurance companies, doctors, hospitals, dentists, or car companies to charge more than enough to cover a profit margin. It is crucial to understand though that these are not issues of government intervention, they are concerns of consumer demand. If you keep buying from a company that over-charges you, you have personally allowed them to continue operating at a cost higher than necessary. This is where the power of the consumer lies, in demand. Again, I appreciate your quest, and although this may sound like a tirade, I am simply sharing a different perspective with you.

Karen Langan, Fort Myers, FL
Keep your eyes open for rip-offs when receiving health services.
First, I'd like to say that I am touched by the article above, and would be curious how the author finds his actual experience trying to use his new health care/insurance plan. I have been an educator in several different states. When I first began teaching, my health insurance was completely covered by my employer. Now I've moved and work in a charter school that pays a portion of my insurance. I had to choose a plan that I could afford for my family based on my salary. Because my teacher-salary ($35,500) is the primary income of the family, I can only afford health insurance with a moderately high deductible ($2500 each person). I found one that offered annual wellness visits, so I thought this was a good compromise. My husband and I recently began to try to use this "annual visit." We have noticed there is somehow a huge disparity in the terms that our health insurance company uses and those used at the doctors' offices we visited. In each case I have been cautious to use a doctor that accepts our insurance and have been very clear to the office that this is merely a maintenance check-up offered by my insurance company free of charge. And in 3 instances now we have been charged between $80 and $150. The doctors' offices have claimed we did not use the correct term, so they didn't know how to file it to the insurance companies, or that it was a new-patient charge we were not told about from the beginning, or that there was a diagnosis (that we were not made aware of ). Only my new OB-GYN did not try to charge for my visit (nor did I receive a bill of asking for additional payments from my insurance company). Still, he prescribed a mammogram for me, and I am very hesitant to get it because I cannot afford portions of that not to be covered. I know it may seem petty to be making noise and haggling over $80 to $150 charges, but these are supposed to be free annual services. I am a bit nervous about what we will be faced with when either my husband or I are actually sick. I hope those nerves don't lead me to get sick. And I hope that the good doctor above has better luck than we do when he tries to use his new insurance.

Nita Obrien, Vilas, NC
Insurance challenge
I truly honor what you are attempting to do. Our system of health care is not about prevention. It is not about comprehensive health care where Dr's. are encouraged to take the time to communicate with each other about what is best for the individual patient. I am sixty and luckily in fairly good health. I have had no health insurance for the last few years and have paid out of pocket for all services. Between my one prescription and minimal visits, necessary tests, removal of a couple of skin lesions, glasses and dental care it is by far the largest deduction on my taxes....and takes well over a third of my income. It changes my life in small ways. I long ago stopped worrying about it every day, but I don't do things I would normally love to do that would add quality to my life, like certain sports (I live in the mountains and would like to ski) or traveling over seas for fear of something happening that I cannot afford to pay for. At least I don't need to go see one Dr. for permission to see another one (and waste money and time) I can usually just make an appointment although you often receive a "certain look" that you are somehow making your own diagnosis. I recently had tests for vitamin deficiencies and did in fact have lack of vit. D due to using sun screen. I still do wonder what will happen if I get cancer or heaven forbid I come down with Alzheimer. Will anyone even treat me and if they do I will quickly become destitute. I know I am not alone in this worry. We need a system that takes insurance out of the equation. Over half of the staff in the Dr. office are paperwork pushers and phone callers for insurance and billing. Think how much the focus would change to care of patient if insurance where not the focus. Thank you for you're efforts. Oh, by the way, I cannot afford health insurance because I would have to give up all the health care that I pay for out of pocket. So I get to choose, minimal health care or insurance.

Pat Siler, Murphy, NC
The Other Side of Employer Sponsored Health Insurance
I am on the other side of the fence of employer sponsored health insurance. For years I worked for the local government or in private business where health insurance was one of the perks I received and one of the reasons I accepted the job. When I left my former job as a paralegal to pursue our dream of living in the mountains and becoming a self employed potter, I was told by the agent who wrote the policy for the law firm for whom I worked, that I could keep the insurance as long as I needed so long as I paid the monthly premium of $650. I did so only to find out in 18 months that the insurance would terminate. When I moved, I had to find another doctor who ran a plethora of tests (since I had insurance to cover everything). The notes she place in my file stated that I was diabetic. I was never diagnosed with diabetes (I am borderline) and have never taken medication for diabetes. Needless to say, at every visit, she wrote more prescriptions. My husband and I tired of having to take a handful of pills every day and switched doctors who immediately took us off 90% of the medications the former doctor prescribed. Long story short, when I had to shop for new healthcare coverage, the former doctor's records showed everything that has ever afflicted me, (and a few extra) down to plantar faciatis which has been resolved. Everything together put me into a higher risk category and the lowest rate I can find is $1300 a month. Even if I could afford it, I refuse to pay that into a health care plan. It is ludicrous. I am 56 years old and face several uninsured years before medicare. So far, so good, but at any moment, I could be taken out by anything and the money we worked so hard to save be in jeopardy. Insurance is a merry go round and a major problem for doctors and patients. Wouldn't it be great if a system could be found that would forego insurance altogether and let the doctors be doctors instead of insurance experts? It would be nice to be able to pay for a doctor's visit instead of the overhead included to handle the bills.

Reuben Last, Albuquerque, NM
The Vicar's Egg
We look forward to the results of your hopeful search. Indeed, Medicine does a appear to operate in a bubble, the skin of which is very thin. The insurance industry, hospital administrators and medical folks who are encouraged to operate insulated from the realities of the uninsured need not be appeased. The status quo and it's watered down decidedly 'Not' reform is a bad egg, regardless of the "parts of it that may be excellent". We are tired of it be contemptuously being served it again and again.

Mark Brant, Goodlettsville, TN
Health Care comments by the Doc.
You must be kidding. This is nothing more than a "lets make the Obama plan reasonable and acceptable because its really so bad, and everyone works so hard but can't afford basic insurance and that's awful, or they pay high deductibles, and you know this is really the worst health-care system in the world." Liberals think that someone else has to pay for what they want. Well here's a flash...the others-you know the ones who have a good job and pay unreasonably high taxes already... they are the ones paying the bills now. They do most of the bill paying in this country. Our government is not capable of running anything efficiently or effectively. When they do touch any operation...the costs go through the roof, the service to the consumer is very bad and there is no way ultimately to take back what powers you give them. I've decide that I'm not buying anything. I will not participate further in the "socialization" of this sacred Republic. This year I was to buy a car-Will not do it. No big ticket items. No home improvements, no extras. When these folks are gone then I will see what follows and make decisions then. I, like some others, do not wish the success of such an approach to governance. And Doc, don't you get it! You do this because you can. The numbers don't add up, the science is just not there, and though I have no doubt you are capable and intelligent...on this day, on this issue, you have been educated beyond your intelligence. For Politicians who vote for this "junk-care" I will simply vote against them in the next election-No matter what party or how much I may agree with other policy positions et...I will vote against them-It's that simple for me, and if I'm correct getting more that way for a great many others.

Deborah Terreson, Portsmouth, NH
I Choose to Purchase Health CARE
If I get to an emergency crisis point with some truly horrific illness like cancer or whatever.. I will probably not seek any more treatment for it than pain relief. I had a taste of protocol-driven healthcare in 2003 and suffered needlessly from a protocol that the MD *admitted* she had to follow. After 22 months of illness that shattered any trust I have in American medicine I can honestly and sincerely say, NEVER AGAIN. As it stands now, the insurance dominated, protocol-driven nature of healthcare IS too low quality for the cost of the premiums I'd be paying to the ponzi-schemers who run insurance. I really do NOT care about the retirement desires of anyone in the insurance industry, nor the wishes of them to put their children through college.. given the screaming low quality of the care they broker for their customers - and anyone else for that matter - I think this disregard is well deserved. Speaking as one of the 48 million ununsured.. until NO one in the insurance industry makes more than 45 grand a year.. and no more medically UNTRAINED insurance adjustors determine the scope and nature of care that any individual will get.. thanks but no thanks.. I'll pass. Insurance isn't the answer in healthcare... it's the problem.

Bob Malone, Houston, TX
Leadership means "Follow Me", not "Gimme"
Dr. Nicholson is putting his money, and his reputation, right where his mouth is - a feat none of our Senators, Congressmen and Administration members have yet to do. They still insist on special programs for themselves while they legislate inferior opportunities for the rest of us. Until our elected officials personally participate in and rely on the programs they enact, like Social Security and medical services, our nation will continue to offer only second-class citizenship to most Americans. I congratulate Dr. Nicholson on his article. Fifty million Americans cannot afford health care OR health insurance. That's a disgrace for a country which calls itself great.

James Scott, Leesburg, FL
Forced into bankruptcy
In 1996 i was diagnosed with atrial fib. which led to heart failure. I was self employed with 2 preteen sons. Needless to say I had no insurance, and after my diagnoses I could never get any. Anyway I ended up hospitalised having 2 surgeries. Neither helped, But I ended up with 140,000 in med bills, and a condition that wouldn't let me work. So my wife ended up cleaning houses and I in bankruptcy court.

Gene Horgos, Howell, MI
Congress's incentive goal for a solution
I believe in the adage of "walk a mile in another man's shoes". My suggestion is that we stop all lobbyist funding to politicians, and then we take away all medial insurance coverage of all congress members until they come up with an acceptable solution. I am tired of congress always putting themselves ahead of the people they are supposed to be serving. I am now starting to get tired of Obama becoming more of a politician and not our leader. It appears the congress mentality is rubbing off on him. We voted for change and "yes we can". President, go and bring it to the people big time, not to congress, you will get nowhere and be defeated by their aristocratic mentality.

Jim Bonner, Camden, AL
Walk a mile in my shoes
Doctor, my hat is off to you. I have found that the only way for me to learn something new is to put some of my time or some of my money into the learning. You are doing both and I hope you will share what you learn with all of us. I have had my insurance both ways now, and currently have the high deductible self funded private plan. It has all been outgo in the form of premiums and so far I have never received a penny in benefits. To add insult to injury the plan provider just sent me a letter raising the rates and doubling the deductible. I mention this, because even after you have bought the insurance, you will find that the rules can and will change as the insurer sees fit to change them.

I.I., New York, NY
Good luck
Good luck! I hope you succeed in your mission.

Lisa Williams, Oak Island, NC
Look forward to more from Will Nicholson, M.D.
This type of problem solving technique is very noble and sorely needed. We need more young analytical minds thinking outside the box, using their energies to focus on issues and challenges such as the health care system (and maybe even the medical school process/system). I applaud Will Nicholson, M.D. efforts and look forward to hearing future comments derived from his research.

Danilo Gopez, Holts Summit, MO
Health Care For Profit
As long as cost for health care for humans are based on profit this problem of half of the people being uninsured will never be solve. The system should be universal for the poor as well as for the members of Congress. That is to say that health care treatment should be based on the need of the individual not his or her status in society.

William Robert, Lafayette, LA
Young , dumb and caring
Poor fellow, fresh out of college, the most unreal part of our lives and can't even make the step into the real world without trying to drag everyone into the liberal utopia of la la land. He better get ready for skyrocketing malpractice insurance cost and a parade of frivolous lawsuits made possible by our wonderful congress and President that are owned by trial lawyers. Practice a while and then send the lectures.

Tom Macpherson, Atlanta, GA
First Steps in Health Care Overhaul
While I applaud the concept of your study, your tone suggests your research results might just support your current bias. As a consumer of both employer-paid in self- paid health insurance for years, here are a few of my ideas: 1) Make all members of Congress subject to whatever health plan they develop for the rest of us; 2) Have the fed government draft 3 to 5 model insurance policies (including difference coverages, co-pays, deductibles, etc.) and require that each health insurance company post their price for each of these policies on one web site. Then consumers can make real informed decisions; 3) Require that all able-bodied citizens who are unable to afford health insurance provide some community service (work in soup kitchens, sweep streets, etc.) to qualify for free health-care; 4) Deny extensive healthcare to anyone in this country illegally. Patch them up, and ship them back to their country of origin. As a country we are neither God or Heaven, so we must stop pretending; 5) DO NOT, under any circumstances, allow a government-run health insurance organization. If you want to see how that program will work, then visit any VA hospital - to see how our government treats our heroes!

Mike O'Connor, Jackson, MI
One question keeps coming to my mind during this healthcare debate. If your healthcare system is as bad as everyone says it is, then why do people come to America when they are sick?

Iliana Martinez, Miami, FL
Voiceless in America
I agree with this doctor--can we meet. I already have the experience you are looking for, but I do not have the experience you have as a doctor. I have documented everything. If possible, please get in touch with me in Miami. To add, I am an educated person with a Bachelor in English, graduated with high honors, summa cum laude, and I have a Masters in Liberal Arts. Currently, I am studying for the LSAT.

Steven Bassett, West Hartford, CT
Consider becoming a cash pay primary care physician
Doctor Nicholson, Thanks for sharing your experiment in non-employer based health insurance. One idea that is gaining traction of the idea that primary care functions more effectively as a cash pay arrangement - that insurance is a better fit for inpatient, outpatient, specialist and certain diagnostic needs. The fascinating point here is that prices that a PCP in independent practice can charge go down as they no longer deal with Medicare and private payers - there is much greater flexibility and effectiveness as you move away from coding and billing. Primary care charges might be on par with auto maintenance. For example you can offer a simple fee schedule for 15 minute increments with a sliding scale at your discretion based on patient income, eg: $50 level 1 complexity, $60 level 2, $75 level 3. Another interesting point is that physicians that have moved this way find themselves doing a better job coaching patients to better health, and they are including additional services such as supplying electronic personal health records. If PCP services are not included in an insurance policy premiums may go down as much as 20%. As we have long heard: Third party payment does get in the way of the patient doctor relationship.

John Clow, E. Norriton, PA
An extremely good premise
Although I don't believe Doctors are the cause of all the hoopla, I just want our 'representatives' to have to live with what they prescribe for us! It is easy from an ivory tower approach to say what everyone else should live with, so long as it doesn't affect you! My very biased belief is Health Care is NOT A RIGHT! We individually should select and work to pay for the services we want or need and that involves making choices that can affect our lifestyle

Shannon Dillman, Indianapolis, IN 
You make an interesting assumption
You assume that you CAN purchase health insurance. You're a strapping young male, so you probably can. I encourage you to try to get quotes for someone 30 years older, and/or someone with a common chronic condition. You may find that "your" diabetes precludes you from insuring yourself against a catastrophic case of appendicitis, or multiple fracture, or ruptured disc. Or you may find that you can obtain something, but it has riders, exclusions, waiting periods, and will set you back $2k/month. Find the median salary for your area and figure out how you're going to pay for that. The next thing I'd like you to do is to pay the "usual and customary" charges for your prescriptions and care. You will find those charges to be neither reasonable nor customary, and you will often find them to be non-negotiable. They will be upwards of 2x or sometimes much more than the reasonable and customary rates negotiated by insurers. Next, shop around for a doctor when you feel a little something coming on, or better still, when you are feeling fine and just want a checkup. That's the smart time to do it. But I'd like you to try the same shopping exercise when you have just broken a limb, or a loved one is ill and getting sicker by the minute. Let's assume you've carefully shopped for your family doctor, you make that frantic phone call, and your doc is not available - even doctors need to sleep - but a colleague can be found. You need a doctor Right Now, you are not in your best frame of mind, you need this person to do you a favor by squeezing you in, and you're going to ask about their fees and how negotiable they might be...?... Doc, if I were you, I would strongly re-consider jumping without a parachute. I'd think long and hard about strapping on that employer coverage, because if you get hit with cancer, diabetes, or even a pregnant wife, your health care options will start to fade, and your noble exercise will turn into horrifying reality.

B.C., Perry, MI
Per, Dr. Nicholson's article
Young Dr. Will, in his haste to jump start the multi media component of his nacent career, stubs his toe early on; his own words shout his intrinsic bias. You can't just say you're being objective - you have to enforce objectivity. None of our "government enforced" hoops are easy. IRS forms are heinous and it goes down hill from there. Even our elected representatives don't or can't read the tsunami of fine print vis-a-vis their own health care options. Will, wait until you have to navigate your own course through malpractice insurance... I believe your article is well meant, but callow. However subtle, or nuanced, the gist of your text reeks of partisan political bias. best, Dr. Jami

Charles Turpin, Minneapolis, MN
Health Care Insurance
Dr. Nicholson's article is on point. What he did not include is the fact that health care insurance and medical care in general is subsidized by the government for those who are well off but for not those who are not. Here's how: If you receive health care insurance from your employer, its full cost is tax deductible by the employer and tax free to you; if you buy it yourself, you use after tax money that, at best, is partially tax deductible. If you earn enough to make itemizing your deductions worthwhile, part of your medical expenses may be deductible. How can anyone consider this to be fair?

Bill Daniels, Centennial, CO
Healthcare is a service not a casualty
The whole healthcare debate starts to go wrong as soon as the subject of insurance comes up because "insurance" is the wrong concept. Healthcare is a service like electricity or water, not a casualty loss like the sinking of a ship. Buying healthcare 'insurance' is conceptually like buying 'insurance' to cover your electric bill. That said, the high-deductible insurance plans the author mentioned might still have a place. For example, what if the government provided basic preventative healthcare up to say, $15,000 a year for all citizens and let the private insurance companies offer low-cost $1,500 deductible policies to cover the unusual, unexpected medical "casualty losses"? That would let insurance act as it is designed to by covering unexpected losses and get the preventative care the author likes to the whole citizenry.

Zel Zellner, Reading, PA
Valuable insights in a weekly column?
It would be valuable to hear this doctor's insights along the way. I encourage him to start a blog, or find a media outlet that will provide him with a weekly (monthly?) column for sharing his findings.

Cynthia Pauwels, Spring Valley, OH
Universal health care versus universal insurance
From It appears that, once again, politicians have caved in to special interests and gotten their highly touted version of reform all wrong. Rather than tossing the greedy insurance and pharmaceutical lobbyists out on their respective deaf ears, Washington has creatively developed a new program that will line the pockets of the health care industry even more. The number of uninsured would be reduced, certainly, but will we be any better off? Not even remotely. An insurance policy does nothing to guarantee proper health care. Any meaningful reform of the misshapen health care system in our country must begin with breaking the stranglehold of insurance companies which stand between patients and doctors. No bureaucrat in a distant office building should be able to determine what treatment plan is right for my health needs; that is my decision to make, with the unfettered advice of a doctor of my choosing. Insurance companies then must be replaced by a single payer system that covers medical attention, not paper shuffling. The idea that forcing every citizen to carry health insurance will improve the health care of us all is a misnomer, at best, and a shameless scam on its face.

My family and I have had employer-subsidized insurance for years, but the premiums and co-pays are prohibitively high enough to keep us from accessing the care we need. And each time we change employment, or an employer looks to save money on premiums, we switch insurance companies and go through the all-too-familiar paperwork ritual which, while I am certain it provides jobs for the clerical staffs, does nothing to improve our health care. And it goes against the grain to be forced to buy health insurance, not only because it enriches the already rich industry with no visible benefit to the consumer, but because I am an adult, an individual who is responsible for my own life. My husband and I take no prescription drugs and rarely visit a doctor, yet we pay over $500 each month for employer-subsidized health insurance -- rather steep for the occasional dental visit and bi-annual eyeglasses. I can’t keep up with what his employer chips in since it changes every year as they jockey to keep costs down while the insurance companies reap ever-greater profits. I have no problem sharing the economic burden of a universal health care system, a la Medicare, if every resident is guaranteed basic coverage no matter their employment status. Tummy tucks, nose jobs and sex changes, and treatment for self-imposed illness and injury from poor lifestyle choices, should be electives, available only to those with the ego and dollars to afford them. I understand the arguments connecting poverty and poor eating habits, but in a society where information overload is the norm, no longer can anyone rely on the excuse that they didn’t know eating McDonald’s daily is not a good idea. As individuals, we must become more responsible for our own physical and mental condition so the system can truly become health care, not sickness care.

Yes, I voted for President Obama. He promised hope instead of more of the GOP terror, peace instead of senseless war. I am still holding my breath, waiting for the changes we so desperately need as a country. But as long as partisan politics continue to plague Washington and the nation, I doubt that change will become reality.

Kate Brown, Sacramento, CA
I agree and support you!
Dr. Nicholson -- I applaud you for tackling this issue head on as a health care provider. Your perspective is invaluable. I too do not agree that an employer-based health care system is fair. As an independent contractor for over 20 years, I did without health insurance as the alternatives were unaffordable and not comparable to the plan I had while working for my former employers (mainly at hospitals). It wasn't that my job was less important after I left to become a 1099 worker versus a W2 one. It's that hospitals no longer wanted to pay my (and others) benefits and found a way to get around having to do so by allowing me to do the same work from home. How can a matter of health care be treated so carelessly? There must be a better solution to the health care mess this nation faces than employer-based health care. I hope you are successful at bringing your findings before those who might then really start an honest dialogue about fair, affordable and equitable health care in America.

Abercromie Finch, Phoenix,
Brave Decision
Mapelwood doctor gave up his health insurance because he is young, he might be unmarried and he might not have any health problems. If he was suffering from some medical ailments, if he was married and wife was not working and had a kid then he definitely might have given second thought about giving up his health insurance. It is very brave thing to act by giving up when it is not affecting you in a way it affects other. I will give my health insurance too if I might be in same situation earning more than 95% of us population and other described features.

Allen Keeler, New York, NY
My Employer Paid Healthcare Plan - Letter to the President
Dear Mr. President: A number of organizations including some representing you have emailed me asking me to support your healthcare reform proposal in a number of ways. I have yet to see a specific proposal of any kind to support. What I am hearing and reading leaves me uninspired. I have the decided feeling that my personal healthcare, which suffers from the lack of ability to meet the co-payments required by my employer provided HMO, will remain unaltered. Further, it is beginning to look as if I will in some way get to pay more for this insurance even with its limitations. There seems to be a mistaken assumption that everyone who has insurance has access to good care. Maybe the Congress is confused by the rather inexpensive comprehensive plan they have, thinking all plans are like theirs. While I may have better healthcare than some, please explain to me why I should pay more for healthcare that remains essentially mediocre for me, while a Congressman’s plan will remain unchanged and his pocketbook unaffected. Additionally, it is beginning to seem as though what is being pursued is a way to protect the business of healthcare rather than provide good healthcare. In spite of the rhetoric, healthcare reform does not seem like healthcare overhaul. Perhaps you should be addressing our entire system and approach to our healthcare culture, overhauling our culture rather than just reforming the business. If you do not, you may risk throwing the baby out with the bath water. Maybe there should be less rush to pass a bill and more care taken to pass a good bill. Haste makes waste. Now there is a solid Americanism that still applies.

Joseph Matta, New Orleans, LA
Highly Idealized, Impractical if you have significant medical problems
I commend you on your foray into attempting to find out how "the other half" lives. However, I doubt you would have done that if you had multiple significant medical problems. I do - including hepatitis c, hiv and being a recovering addict and know that for me, obtaining the appropriate medical insurance without the help of a group policy from my employer would be next to impossible. I am glad that you are trying to be a voice for those without, however you are still privileged if you can even think about saying no to your employer's health plan.

Dennis Mullins, Virginia Beach, VA
Government Health Care
Government health care is worse than HMOs, I want someone witn medical knowledge to decide how long I should stay in a hospital and what meds to take, not a lawyer or politician!!!

Art Burk, Ronkonkoma, NY
The cost of Health care
Very few people talk about the reasons health care is so expensive. Nor does one hear of efforts to reduce these costs. I believe the scarcity of doctors and the cost relating to lawyers suing over anything involve the major cost of health care. the solution: more doctors and less lawyers. Increasing the number of doctors involve creating more medical schools and providing more scholarships to qualified students. I believe the medical profession consciously, or unconsciously limited the number so that demand outstrips supply, thus justifying higher costs. Reducing the number of lawyers involves legislating limits on jury awards. Both of thses will reduce the cost and increase the health of our nation.

Rosi Lehr, Bradenton, FL
Educating patients is a good start
Sounds like you are one of the better doctors out there. I struggle to find a health care plan that covers standard coverage without charging an arm and a leg and gives you the 3rd degree on your previous visits... I have chosen Golden Rule as they were a good mix. I feel educating patients on how to maintain good health, good regimens such as exercise, water and high fruits/veg low meats and low carbs are important. Our schools need to assist in healthy foods and put PE back in schools where they were taken out.

Patty Rosell, St Louis, MO
Using insurance outside the system
When I started teaching in a public school system, I only had two teenagers left at home(husband had died). I didn't have to pay for my insurance but my children were not free and inspite of all the school districts in the three county St Louis Area pooling their membership together which you think would offer great rates, my health insurance costs for my two teenage girls was more than $500 a month which was financially beyond me as a first year teacher. I went on line and starting comparing costs of private insurance and Blue Cross had a plan that cost me $65 for each child until they were 18 and then reasonable rates as long as they were in college. Their plan included all the benefits the school plan had and I only paid a $20 charge each time they went to the doctor and no deductible. I'm sure there were even cheaper plans with deductibles but I couldn't afford to pay the first $1000 so I thought it would be better for me to go with a slightly more expensive plan and no deductible. Moral: Shop around.

David NLN, Maryland, MD
Dangerous experiment
Hi- My wife and I recently tried private insurance for a year instead of my company sponsored plan. On the surface, it appeared to save us money. In the end, it was far more expensive than advertised or predicted. I am sure everyone is used to getting a bill now for $700 dollars for an office visit, to see that the insurance company pays $100 of that, and the rest is written down under the terms of the doctor's contract with the insurance company. Well, when I had my individual insurance, I ended up paying a good part of that "written off" part - an individual just can't get the false "discount" that the pricing structure assumes. Further, I was always worried that if we had any real health problems (i.e. expenses), the insurance company would have surely dropped us, leaving us in a position without insurance and probably unable to find new affordable insurance due to what would be called a "prior condition".

At the next "open enrollment" period, I signed up for my companies health insurance, which costs significantly more (for me and the company), but I also know that my family won't lose insurance coverage if someone is sick. Even having requested the thick plan booklet, the details of these plans are obscured in terms and conditions, often dependent on the terms of the contract with the doctor, have unfathomable reimbursement schedules, costs are set by mysterious billing codes, etc. All of this being prepared by an army of lawyers to guarantee records profits to insurance companies. Individuals have NO chance of winning the war against the corporate insurance lawyers that set the terms of such polices. To me, one of the fastest ways to level the playing field is to 1) require everyone to have some minimum amount of insurance (just like you are required to carry automobile liability insurance) and then (this is the important part) 2) to eliminate "prior conditions" and the patients health history from the purchasing process. Yes, that does mean that high risk individuals are probably being subsidized by low-risk individuals, but isn't that what always happens with insurance? Can anyone honestly say this is not the case for automobile insurance which operates fairly well within a government regulatory structure? This second part will become more important as more genetic information is available - it won't be long before insurance companies will easily be able to cherry pick patients with little risk of expensive disease, leaving those with higher risk out of luck.

Robert Medvedenko, Rockford, MI
Thank you!
I appreciate your understanding of the issue. Why would anyone on the employer insured side of the equation want major change? And if very few on the self-insured side have a voice in the debate how can their plight be truly understood? I was "downsized" (actually my company used the term "globalized") in 2000 after 18 years at a very large company. At the time we had three children under the age of ten. The first shock was that "Cobra" coverage was over $1000 per month. This was when I started realizing that the system is unbalanced. If you have a job you are rewarded by paying low monthly contributions and co-pays but when you have no income or attempt to start a small business (where money is very tight) your health insurance costs increase ten fold! As an employee for all those years I had no idea what my health coverage cost. Once Cobra ran out I had to find private coverage. I was rejected by private carriers because my wife has asthma (a common pre-existing condition). They offered to cover me and my children but not her. This opened my eyes to how insurance companies "cherry pick" only the healthiest people tossing the remainder on the medical scrapheap. The other issue was prescription coverage. Asthma is a chronic, life threatening condition, meaning that it is never cured. When I was employed we paid $10-$20 per prescription (maybe it was $5-$10?). We had no idea what the medications actually cost! Which is insane.

When we became self-insured we found out that her prescriptions were over $400 a month and insurance would only cover 50%. Since we had to use BCBS of Michigan (insurer of last resort) it was a take it or leave it proposition. This is just a small snapshot of the decisions a family has to make when faced with finding individual coverage. The other broader issue is that it kills small business development which generates jobs (people can't leave their jobs to start a business because of health and dental insurance). I would think conservatives would understand this. Lastly, it kills the economy because every available penny goes toward health coverage, including, in our case, 401K money saved for retirement. It's an insane, backwards way of doing things that needs to be reformed but will probably have to collapse before something substancial is done to fix it.

Paul Fernhout, Edinburg, NY
Time to research plans is the first luxury
It is easy to despair at the current news for a mandate for all people to buy health insurance with all the silly parallels to buying car insurance (like people can chose not to have a body and take mass transit instead, like half of all cancers were not external costs of industrialization, like advertising doesn't supersize people into obesity, like tax dollars don't fund much basic research that drug companies skim the cream off the top of, etc.). You are absolutely right it seems that policy makers don't have a clue -- or, less charitably, have been captured by vested interests or group think. Essentially, the current mandate proposal is a tax on the young, part of an increasing young vs. old divide in this country. The old have a basic income guarantee through social security as well as socialized medicine via medicare, but the young have to pay for that and don't get similar social benefits even while raising children, other than compulsory education the trains them for factory jobs of the 1850s that don't exist anymore. Rather than invest in immortality by supporting the next generation, the old are trying to get immortality through medicine. Maybe they will succeed someday, but it is rough on the young who have no access.

While you no doubt mean very well, even your attempt here goes off the rails very quickly. The first issue is time -- you have the time to evaluate plans and then the time to apply for them. How is an average working person supposed to have that time? You also have the analytical skill to make such choices. Then, you have the knowledge you are playing a game, that you could have easy access to health insurance and health care if you wanted to, so the process is less stressful. Take a look at the movie "Sullivan's Travels" for some more insight into poverty -- though even that misses a lot and becomes an apology for the media industry abandoning journalism. The simple solution is to extend social security and medicare to all -- without regard to income (see "basic income" on wikipedia, or look as Marshall Brain's online books "Manna" or "Robotic Nation"). Ultimately, something like that is what our society will need to do to survive increasing automation and better design reducing the need for workers given limited demand for consumer goods as the best things in life are free or cheap. These best things include preventative oriented health care including good nutrition, occasional fasting, good sleep, friendly relaitons with neighbors and family, moderate exericise, spirituality, experiences in nature, and so on. But you can't fix that issue by itself, just pushing pills to cover other social ills. It's a totality. Greece has seen riots about related sissues (lots of educated kids, but no jobs or hope). The USA has been lucky so far to avoid this. Essentially, a well off person with good job prospects has a hard time seeing any of this. Still, I applaud your taking a first step.

Lee Irvin, Shreveport, LA
what would u expect from a liberal from the state that gave us Hubert Humphrey

Kevin OLeary, Austin, TX
The good doctor is mistaken when he suggests that 50% of Americans do not have health insurance. The figure is ~45M out of 300M citizens - or 15%. Furthermore, Investors Business Daily recently showed that 1/2 of of the 15% can afford insurance but choose not to buy it. They instead choose to manage the risk individually. Please stop creating a crisis where one does not exist.

Lenore Pryor, Ft Myers FL
What is not covered
I am one of the lucky Americans covered with employer subsidized health "insurance." Although, most basic needs are covered. I would really like to understand why basic dental care is not covered. I learned from my dentist that not having regular dental checkups and cleanings (basic regular care) can cause heart problems, infections in sinus that can be very serious, impact your diet (if your teeth hurt it's hard to eat a well rounded diet). The other area is smoking cessation prescriptions. It would seem to make sense if smoking is such a big health risk, that insurance should cover the cost of prescriptions to help you quit. There is one medication that goes by two different names. Prescribed under one name as an antidepressant it would cost me $10 per month (it would be covered). Same exact medication under the other name, prescribed for smoking cessation is not covered and would cost over $100 per month.

Mike K., St. Croix Falls, WI
Health Care Fairness
My wife and I, along with our four children experienced first hand what it is like to lose both our jobs and accompanying health insurance. We have lost all our savings, and (related to a degree) our 401k values and now are just trying to save our over valued mortgage. As a matter of fairness, why don't we get the same Gold Standard health care that our elected officials get? Both Democrats and Republicans need to lose their coverage so they can understand the true scope of the problem. They have no vested interest in health care because they don't need to worry about it, it's just there for them without any effort on their part. I say put us all on their insurance pool or remove that benefit from their employment. Ironically, the very Republicans and some Democrats who vote against a public plan are the same people essentially receiving a tax payer funded benefit.

Will Nott, Tomball, TX
Even more enraging
I agree fully with Dr. Williamson's article, but I have experienced what seems to be an even greater source of anger by observing the difference between negotiated cost and "list price" of "care providers". The sense of rage is caused by the fact that anyone who does have health insurance can "benefit" from the lower rates which the insurance company has managed to negotiate with providers. *BUT*, those who most need the care - those who are in the unfortunate position of NOT having insurance (due to various causes, but most frequently unemployment or other economic challenges) can NOT take advantage of the lower cost pricing, but are stuck with having to pay the "list price" for any service they seek. These costs are often 2 or 3 times (!!!) the negotiated rate which the provider is willing to accept from insurers / insured patients. It is even MORE enraging to realize that this practice is NOT limited to large institutions, but extends down to the individual Family Practice or specialty practice doctors offices. It is almost impossible to fins any "provider" who will agree to settle for the negotiated rate in cases where patients do not have "coverage". So, what is wrong with this picture? Why, oh why in an area where providers talk about "patient CARE" do they consistently exhibit such a NON--caring attitude when it comes to the financial side??? I humbly submit that NONE of the current aspects being duscussed in Washington address THIS aspect either. We are all suffering from the recent escalation of public values that emphasize economics over integrity. I also submit that unless this nation changes our "track" and will agree to work on changing VALUES instead of attempting to steer the economics, the picture will not change.

Ernesto Migoya, Houston, TX
Thanks for your honesty
Thanks for your hard hitting honesty. I appreciate your compassion and honesty. I wish that you practiced in Houston, Texas so I can sign up as one of your patients. Good luck in this venture and I hope that you will be a strong part of the solution to the health care crisis in this country.

Donna Dozois, Palm Coast, FL
An MD that makes sense!
Good work Dr. We must confront the quality of care in our country, though. It is not just insurance or lack of insurance that is the problem. We ranked 30th in the 2000 WHO rankings of countries in health care quality. I have seen a big deterioration in our health care from the 1980s and 1990s. Health care has become a big business with exorbitant prices by the suppliers, the manufacturers, the drug companies, and many MDs whose only concern is making money. I hope you are an advocate for improved quality as well. Thank you.

Rick Withheld, Portland, OR
Look Around
Since this is the only country in the entire world where no one ever goes without, I find it hard to hear that you say that half of the country doesn’t have insurance. Last statistics I read said that of the Americans, only 8 million out of around 300 million don’t have health insurance. And everyone has full and complete access to emergency care anywhere within the US. I also know that we have the best medical system, with breakthroughs and new ways of curing cancers and other problems that other countries simply don’t have because of their “public” systems. I would like to know why so many people from other countries come to the US to get their procedures done when our medical system is in such disarray and the “public” system is so much better. I agree that some changes need to be made but those involve getting the government out of the way of the businesses that own and operate the hospitals and insurance companies so they can grow and find better ways to do what they do. And patients need to learn to say no, when it comes to unnecessary tests and procedures. They also need to start asking what this is costing because thinking that the insurance is going to cover it is not doing anyone any favors. The people need to control their money and their healthcare, not the government or insurance companies. That would fix the system.

Ray Arthur, Gulf Shores, AL
Fund Medicare And Have Policy For Insurance Oversight
I agree with the family physician that monthly healthcare premiums should be lower and the coverage should include preventive healthcare. Medicare patients are growing in population annually this is increasing costs for the government - not what doctors or hospitals are charging. The government has been complaining that heathcare is more expensive year after year without telling the American people the truth about why costs have increased. THERE HAS BEEN NO COST INCREASE TO THE GOVERNMENT - ONLY MORE RETIREES!! The government PAYS LESS to physicians and hospitals every year to make up shortages in the medicare budget. It is time for doctors to go to a cash or credit only and not accept any contracts from the government or private insurance companies. Reducing medicare reimbursments anymore will collapse our healthcare system.

Paula Newell, Denton, TX
Hang in There
I too graduated into an honorable profession with lofty goals and expectations of making a difference. As a new teacher I wanted to reach those who had been unreachable and change their worlds. The barriers are unspeakable. Persistance and dedication young doctor. And God bless you!

Thomas J Huber, Columbia, TN
Where do we stop?
I am a retired orthopaedist. I have some health problems, which means that I am "married" to my insurance carrier, and between my wife and me we pay almost $30,000.00 (no typo) a year in health insurance premiums. Still, we are not going to solve the health care problem until we decide, as a society, what we are going to pay for, and what we are not. Do people on welfare need Viagra and infertility treatments? Do we spend millions on drug-addled 2 pounds preemies? Do we keep old geezers (myself included) with terminal cancers in the ICU for months? Does every backache merit an MRI because some shyster working workman's comp. cases threatens to sue? Until we answer these, and similar, questions solving the health care crisis will be nothing but a well-meaning but useless exercise in lip-flapping. T J Huber, MD

Tim Collins, El Paso, TX
What Value do Health Insurance Companies Provide
In the previous article I asked a simple question. What value do HEALTH insurance companies add to the delivery/availability of health care? And I proposed consideration of the possibility of providing Health Insurance through a mutual or non-profit operating model. Let me begin by answering the question first. What value do HEALTH insurance companies add to the delivery/availability of health care? The question may be simple, but it grows complex when you try and answer it from the perspective of the different stakeholders: Health Care Professionals (Doctors); Health Care Provider Companies (Hospitals); Government Agencies (State and Federal), and last but not least, Patients. If you ask any of the Health Care Professional groups you would get a mixed answer to the question. After reading numerous annual reports and 10K filings for Health Care Companies (Medical Facilities, and Pharmacy), I have found that all provide the same basic answer regarding the value Health Insurance companies provide. Health Insurance companies do deliver the health consumers -- patients, but at a cost that is becoming unbearable -- smaller and smaller levels of reimbursement.  For more:

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