Let's Not Be Stupid About Health Care Reform

In the mid-1990s, after presenting a talk about the HIV-Infected Health Care Worker at the Tenth World Congress on Medical Law, in Jerusalem, Israel, I met with three medical directors of what would have been Israeli equivalents of three large American HMOs. Each of these men were serious, committed, knowledgeable and depressed about the status of organized health care for which he had responsibility. In each case, the influences of poor lay business management, ethnicity mixed with religion and politics, and budgetary shortfalls created a wasteful system which met none of the reasonable standards to which these directors were committed. They said that the care their organizations provided was substandard.

There is a lesson from this experience. When I recently proposed a health system for all Americans with a single independent federal payer, I also proposed a federal health corps competing with traditional HMO and insurance health care systems because I understood that unless a new health care system had competitive safety valves, it would fail. Unless there is a single responsible "inspector general" for the quality and availability of care for all Americans covered by our health system, patients will suffer. Unless there is a real downside to providing unnecessarily expensive, inaccessible, inappropriately limited preventive care, diagnostic testing, therapy for illness and a full range of appropriate pharmaceutical (and other) products and services, mediocrity will prevail here, too. And unless we construct an ethical and moral framework for our health system, we will have not done our job.

Listen hard to President-elect Obama's health care plans. If they don't incorporate a consensus on American ethical and moral health care standards, the influences of poor business management, ethnicity mixed with religion and politics, and budgetary shortfalls will creat a wasteful system which does not meet our families' needs. We need change, not the old system in new clothes.