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.

A Time For Forgiving Credit Card Health Debts

In the Jewish religion, for more than two thousand years, this has been the time of year when Jews were commanded to forgive the debts, and interest on the debts, of indigent citizens.

These days, people undertake to pay for health care with credit cards. Patients and their families have little understanding of how quickly costs will mount, expenses will grow, and their resources devoured by sickness, by professional fees, hospital costs and ancillary services. Insurance pays only a portion of health care costs: the remainder goes on the credit card.

In America, health care credit card debt will not be forgiven, no matter how pressing the need for services was, how dire the patent's situation, or oppressive the health care service provider's billing practices might be. Congress has prevented credit card debt from being discharged in bankruptcy and, as a bankruptcy judge told a group of us who were assembled at a bar association meeting, medical services charged on credit cards are a major cause of patients' (and their families') financial collapse.

In this season, isn't it time to forgive the credit card debt, and interest, incurred in preserving life and health? If we can extend help to bankers, investment and financial firms, and others whose debt was incurred in pursuit of satisfaction of their greed, can't we protect - through a return to permitting bankruptcy discharge - those whose credit card debt was incurred to save lives and health?