Love the blog. Ive dugg you in my digg account for future reading!

I can honestly say, after having suffered from End Stage Renal Disease; the care I received in Europe far exceeded that of the USA. Imagine hearing that from the average guy. I fall directly in the middle class cross section of America.

I wonder if any of the people who commented including the author of the article lived under such a system and if the answer is no, then how can you offer a non-biased opinion.

As far as the studies and analysis’ performed, many fall victum to the stroke of the pen, All educated people know the statistical outcome can be taylored to meet your needs by the method and fomula used. Instead of quoting theory and statistics I suggest you go and live it, then come back here and post an opinion.

1. Is emergency care only appropriate health care?
2. Why should society judge a person’s spending habits in order to receive health care?
3. What about rural areas or the non eight cities where John has lived? Are these services available everywhere?

The US health care system is a wonderful system for those that can afford it. For those who cannot, the system is highly inequitable.

In every one of the eight cities I’ve lived, non-profit hospitals were required by law to provide emergency health care to those who could not pay for it. In every one of those eight cities, free clinics dispensed medical care, including immunizations, free medicines, dialysis, prenatal care, and much more.

Of those 40 million Americans who lack medical insurance, how many have purchased non-essential goods and services rather than medical insurance? Certainly the dozen adults I know who lack health insurance could have purchased and still had money left over for food, shelter, and minimal transportation.

My degree is in biology so my knowledge of economics is limited and I’m a long way from being an expert. However, I did enter the healthcare business in 1965; worked in and managed a hospital clinical laboratory for 10 years; was a hospital vice president for 20 years with duties that included contract management; designed and implemented a pilot consumer-driven health insurance plan; served as a medic in the Air Force; and am in the middle of my final edit of a book with the working title, “It’s all About Money! (How to Win the Healthcare War).” In short, I’ve experienced the “healthcare mess” from many perspectives and have formed opinions that I strongly believe but may not necessarily be able to prove.

Principle #1 – I concur that excellence is the result of the enthusiasm, energy and leadership of a few people, and that they are scattered around. However, I do not believe the “scattering” is particularly random or related to the absence of financial penalty for mediocrity.

When I entered the healthcare arena in the 1960s, a hospital could pretty much be all things to all people. By the early 70s, access to new and expensive technology like linear accelerators, chronic hemodialysis, CAT scanners, heart catheterization labs, etc. was being demanded by physicians, businesses, and individuals. I worked in a mission driven hospital and we targeted an operating margin of 3-5%.
With that narrow margin, we had to make conscious choices regarding centers of excellence. We chose heart, cancer, and dialysis and knowingly relinquished excellence in orthopedics, pediatrics, neonatology and some other highly specialized services to competing institutions. Each institution then recruited and attracted physicians and ancillary personnel that were enthusiastic supporters of their centers of excellence be those services financial winners or losers.
Ancillary services, lab, x-ray, etc. were developed to support the centers of excellence. Although I exited the hospital business in 1995 and know things have changed dramatically, I believe that some of what may be perceived today as “random scatter” may be the result of some conscious decisions made 3 decades or so ago.

Principle #2 – I do not disagree, but I do know many high-income people who end up with mediocre or poor healthcare because they are hostage to a provider network (possibly the worst hoax perpetrated upon the American public since chlorophyll). During nearly 20 years of negotiating contracts with insurance companies, PPOs, HMOs, and other weird arrangements, none of the negotiations involved quality issues other than Joint Commission Accreditation – the only focus was on the percent of the discount.

Thanks for the fine work you do at ncpa. jds

John Sanderson
Director of Development
School of Mechanical Engineering
Purdue University

The author’s example of “only” $120 an hour for access to a medical professional is a good one. While this may seem to be within reach of most people, how do these people deal with a $100K health care bill for a severe medical condition? Is a market price system appropriate for these folks?