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<DIV style="FONT-FAMILY: times new roman, new york, times, serif; FONT-SIZE: 12pt"><FONT size=2 face=Tahoma>----- Forwarded Message ----<BR><B><SPAN style="FONT-WEIGHT: bold">From:</SPAN></B> shane que hee <squehee@ucla.edu><BR><B><SPAN style="FONT-WEIGHT: bold">Sent:</SPAN></B> Tue, January 3, 2012 1:01:34 PM<BR><B><SPAN style="FONT-WEIGHT: bold">Subject:</SPAN></B> Arnold Relman on saving the U.S. medical system<BR></FONT><BR>
<BLOCKQUOTE class=cite cite="" type="cite">Date: Tue, 3 Jan 2012 11:35:40 -0800<BR><BR>From: Don McCanne <don@mccanne.org><BR><BR>Subject: Arnold Relman on saving the U.S. medical system<BR><BR><BR>The American Prospect<BR>Jan-Feb/2012<BR>In Dire Health<BR>By Arnold S. Relman<BR><BR>Most people assume that insurance is an essential part of the health-care system. Some think it should be provided through public programs like Medicare, while others prefer to see it purchased from private insurance companies, but the majority believe that insurance is needed to help pay the unpredictable and often catastrophic expenses of medical care. That is why so much public policy focuses on extending coverage to as many people as possible and controlling its cost. I think this emphasis on insurance is mistaken. We would have a much better and more affordable health-care system if the reimbursement of medical expenses through public or private insurance plans was
replaced by a tax-supported universal access to comprehensive care, without bills for specific services and without insurance plans to pay those bills.<BR><BR>Insurance is not simply a mechanism for spreading financial risks and paying for medical care. Because it usually tries to limit payments to providers, insurance often is an intrusive third party in the doctor-patient relationship and, particularly with private insurance, restricts the freedom of doctors and patients to select the services, specialists, and facilities they want to use.<BR><BR>Furthermore, all insurance plans have administrative expenses, and most private plans take profits that add to the cost of their premiums. The billing and collecting operations that are an integral part of any insured health system are a major expense for doctors and hospitals as well.<BR><BR>For-profit insurance companies, which control most of the private market, are the greatest problem. They have a direct
conflict of interest with their customers, because a plan's net income is increased by avoiding coverage of patients with serious illness (who, of course, are most in need of insurance), restricting access to services, and limiting coverage of expensive medical services.<BR><BR>There is, however, a practical alternative to health insurance and the fee-for-service system with which it is usually associated: a not-for-profit system in which a public single payer provides universal access to comprehensive private care delivered by primary-care physicians cooperating with medical specialists in group-practice arrangements.<BR><BR>I do not underestimate the complexity of the changes I am proposing. The odds against it are daunting. Congress might not even begin to debate major reform until the health system is near collapse. But what seems clear is that the best - possibly the only - hope for achieving universal, affordable care lies in the eventual
elimination of private insurance and fee-for-service payment and in the creation of a tax-supported system based on group practice. Although this proposal makes good medical, social, and economic sense, its ultimate fate will be decided in the political arena. It cannot become a reality without an informed and aroused public bolstered by the medical profession's strong support for the reform.<BR><BR>(Arnold S. Relman is a professor emeritus of medicine and social medicine at Harvard Medical School and the former editor of The New England Journal of Medicine.)<BR><BR>http://prospect.org/ (As of Jan. 3, Jan-Feb/2012 issue not yet posted online)<BR><BR><BR>Comment: It seems appropriate to begin the new year with the words of the venerable Arnold Relman. Much media attention on reform will be misdirected this year to implementation of the private-insurance-based Affordable Care Act and to its challenge in the U.S. Supreme Court. Dr. Relman reminds us
that instead we need to move forward with informing and arousing the public in support of fundamental reform that actually would bring affordable care to all.<BR></BLOCKQUOTE></DIV></DIV></div></body></html>