Editor’s Note: David Axelrod, senior adviser to President Obama, released a letter to Americans Thursday informing them of the president’s health care proposal. Here is William Ladd’s response to the letter.
Dear Mr. Axelrod,
William Ladd is a San Diego radiologist.
I applaud your efforts to improve the health care received by Americans. The delivery system is certainly flawed currently. If you really want to make a difference, I believe you need to do the following things, at a minimum, and of course this is ridiculouslysimplified:
1.There should be a major push to evaluate, mostly for the first time, the effectiveness of medical and surgical therapies. The MAJORITY of common medical practices have never been scientifically proven to be effective.
2.The financial incentives of doctors must be altered. Human self-interest is too strong for the current financial incentive, to always do more, to be cost-effective. Excess expensive imaging procedures, especially when self-referred by doctors to themselves for financial gain, and a large volume of unnecessary but highly paid low back surgery are two good examples. There are many more.
3. Patients must have at least some skin in the game. If NONE of their personal money is at stake, the system doesn’t work, unless you want a very highly regulated and rationed system. I have found that people don’t typically ask what a medical treatment or test costs, but instead ask whether it’s COVERED. If it’s covered, they actually perversely would LIKE it to be expensive, since they then are getting a good benefit from their insurance. It is amazing sometimes how small a co-pay can be and still be enough to make a patient decide something he or she simply “had to have” is now totally unnecessary.
4.Tort reform should be part of the solution. Although there are those that argue that defensive medicine to protect against hungry malpractice attorneys doesn’t add a significant amount to the overall medical tab for the nation, it is my expeience that this is a highly significant cost.
Read William Ladd: The growth of the human population is bad
5.Ideally, the plan should include very strong incentives aimed at fitness promotion. Although it clearly is not a constitutional right to receive health care, many regard it as a de facto right. If so, with rights come responsibilities. Should I be required to pay, through taxation, to provide health care for someone who makes no effort whatsoever to stay healthy?
Sincerely,
William A. Ladd
William Ladd is a radiologist in San Diego.
Tags: SDNN
Comment by: Leslie Eastman Posted: July 24, 2009, 2:20 pm
Dr. Ladd: Given the degree of disagreement we had this week, I wanted to underscore how much I agree with several of your points in the letter to David Axelrod. If you could be so kind as to post the address to which you sent it in the comments section, I will strive to follow-up with a letter of my own and get other interested parties to send comments that support your opinions.
I appreciate your perspective here. For example, on military matters, I always listen seriously to men and women who serve in our armed forces. On matters pertaining to healthcare, I weigh the opinions of medical professional such as yourself — you are on the frontlines, so to speak.
Your point on Tort Reform is an especially critical one. Charles Krauthammer addressed this matter in his column today: Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers. (NOTE: I am a Democrat, so this is not a point of pride with me).
As a capitalist, I thoroughly concur that “Patients must have at least some skin in the game.” One of the best examples of free market medicine is Lasik eye surgery. As it is not covered by insurance, people shop around, ask tough questions, investigate the qualifications of their care provides. I had a great experience — for $3500, I had my vision restored to 20/20 with little discomfort by a professional staff in a quality medical environment.
The incentives for fitness promotion is also an excellent idea. My husband’s insurance has a device that permits the monitoring of his exercise regimen. His insurance rates are lower because he stays fit. There is no need to pay for medical care when people stay healthy enough not to need it.
While I can’t speak to point 1 or 2, I must state that I think a lot of testing is being conducted to avoid lawsuits. Tort reform may help eliminate unneeded tests. Furthermore, I would be concerned about the prejudices of any panel deciding on the effectiveness of treatments.
You may be interested to learn more about PEGASUSS, http://stoptaxingus.com/pegasuss. It is a consortium of doctors promoting free-market solutions for much needed healthcare reforms.
Do keep us posted should Mr. Axelrod respond. I would LOVE to know the reply.
Comment by: john cotter Posted: July 26, 2009, 2:15 pm
Thank you Dr Ladd for a voice of reason. There are many things congress cannot do and crafting a sensible solution to a complex social and economic problem seems to be one of them. The president’s lack of effective leadership (let’s just pass it and see what happens, and to hell with the cost) doesn’t exactly help either.
Comment by: William Ladd Posted: July 27, 2009, 11:28 am
Leslie,
Thank you very much.
I used two different addresses for Mr. Axelrod. One was the sending address for his message, which is: info@messages.whitehouse.gov . The other is: david.axelrod@whitehouse.gov .
I have not yet heard from him. I will be sure and let you know if and when I do.
Although it would not solve the lack of access to care, we could instantly solve the high cost of healthcare by simply applying the skin-in-the-game method. People would stop insisting that “everything possible be done” for 101 year old grandma who hasn’t known who she herself is for the last 10 years, has metastatic cancer everywhere, and is on a respirator, if even 10% of the million dollars were coming out of their own pocket.
Really, the expense problem is a direct result of the concept of OPM “other people’s money”. Companies developing new treatments and devices haven’t had to worry about whether anyone would be willing to pay for them. They just had to spend money lobbying to make sure they were covered by Medicare, and then eventually the insurance companies would pay too. Often the insurance companies would pay first, then Medicare would join in.
Regarding tort reform, you are absolutely correct. Under the current White House administration and Democrat congress, that will go nowhere. Philip K. Howard, an attorney and author of “The Death of Common Sense”, believes that the current malpractice law system should be completely dismantled and replaced with a special medical court system. By the way, I believe you would appreciate “The Death of Common Sense”, though it would make you mad to read his examples of it’s death. Though I consider myself a scientist, simple common sense has become paramount to me as I’ve grown older. I cherish it wherever I find it.
Comment by: Jon Limpert Posted: July 27, 2009, 11:36 am
Very fine indeed.
One suggestion I regard as likely to get us a pretty good single payor plan if we, the public, insist on it:
All of congress must be covered on the exact same terms as the public option designed for us. No exemptions for congress or family for any reason, nor for Big O after he leaves office. Same for retirement. No more lifetime salary etc. You get the same 401K and pay the same taxes you design for us.