Dr. Carson on Health Care

Dr. Ben Carson made quite a splash at the National Prayer Breakfast the other day. Elsewhere I discuss the moral vision he provides in his book, America the Beautiful: Rediscovering What Made This Nation Great. But here I want to look at his recommendations for health reform.

Most people who saw the speech were thrilled (or appalled) that he called for universal Health Savings Accounts beginning at birth. This is a fascinating idea that would merit some deeper analysis. Unfortunately, he doesn’t mention it in his book, even though he devotes a chapter to health care.

Instead, his writing offers up some off-the-cuff emotional reactions to problems he has experienced. They are not well thought through and I expect he would write something very different if he had an opportunity to dig a little deeper. Let me start that rethinking here.

drCarson

He begins by writing about what drew him to medicine as a boy, and then to neurosurgery as a medical student. (If you aren’t familiar with Carson’s upbringing I urge you to buy the video version of his autobiography, Gifted Hands).

He then describes one of the problems of providing free health care — poor attitudes on the part of patients. He says their sense of entitlement turns them hostile, and even abusive, toward providers:

Contrary to popular belief, one of the reasons many physicians refuse to see indigent patients is not that they cannot pay, but because of the poor treatment they receive from such patients.

He goes on to complain about the complexity of dealing with many insurers:

Unfortunately, our healthcare insurance system has become so complex that virtually all medical offices and larger practices need billing specialists just to navigate its intricacies. All of this variation and complexity produces mountains of paperwork and requires armies of people to push it around.

He thinks this is all done to prevent fraud. But he says a better remedy would be to impose very stiff penalties on those few providers who engage in fraud, “such as loss of one’s medical license for life, no less than ten years in prison, and loss of all of one’s personal possessions.”

Yikes! The family members of such a doctor would not be very happy about this. But, more importantly, what is called “fraud” is often nothing more than a billing dispute. Indeed, just a few pages later, Dr. Carson relates the story of a physician friend who wanted to get into real estate development, so he sold his oral surgery practice to a colleague. Medicare decided the colleague was engaged in fraud, but he didn’t have many resources, so they went after Carson’s friend as well:

They meticulously examined fifteen years of his practice records for evidence of fraud and were only able to uncover two questionable bills, amounting to a total of $180…He was told that they would take him to trial as a co-defendant with the buyer of the practice and would convince jurors that he had knowledge or turned a “blind eye” to the other doctor’s activity. And that eventually he would end up in federal prison if he did not plead guilty to a federal offense in connection with the $180 discrepancy…He accepted their deal and was sentenced to a one-year house arrest and a $300,000 fine.

This is how Medicare often operates. It chooses not to do simple claims adjudication before paying bills, so every five years or so, it makes a big public relations splash of criminally prosecuting providers who never should have been paid in the first place.

Also, to reduce paperwork Carson would have all payers pay all providers the exact same rate, regardless of their skills or underlying expenses. And he would require all insurers to “become non-profit service organizations with standardized, regulated profit margins.”

He would also “remove from the insurance companies the responsibility for catastrophic healthcare coverage, making it a government responsibility.” He thinks this would make coverage more affordable, because “if we did not regulate utilities, few people would be able to afford their water or electricity.” He would confine insurers to “a 15 percent annual profit, 5 percent of which would go to the government’s national catastrophic healthcare fund.”

Readers of this blog know that I am no great fan of health insurance companies and would like to see their role in health care greatly reduced. They are far too intrusive into the patient/physician relationship and have indeed piled on vast amounts of administrative costs to the entire system.  The idea of universal HSAs Dr. Carson presented during his speech might help remedy all this but the ideas presented in the book are poorly informed:

  • Insurers don’t currently make anywhere near 15 percent profits, more like 4 percent.
  • Five percent of claims wouldn’t come anywhere close to funding catastrophic expenses.
  • Not-for-profit insurance companies are no more efficient, accountable or affordable than for-profit ones.
  • Utilities make a whole lot more money by selling services to the masses than they could by raising prices so that only a few could afford it.
  • The reason utilities are regulated is because they are state-sanctioned monopolies not subject to the discipline of competition.
  • Using criminal fraud to deter false claims is already being done in Medicare, with poor results.

After his prayer breakfast talk, some people thought Dr. Carson should run for president. That is a terrible idea. We don’t need more politicians, but we could use a great moral leader like Billy Graham or Martin Luther King, Jr.  Dr. Carson’s gifts would be wasted by descending into the weeds of public policy and practical politics.

Comments (31)

Trackback URL | Comments RSS Feed

  1. My approach to health insurance includes something very like universal HSA’s from birth.

  2. Ken says:

    Interesting.

  3. John Torinus says:

    Save me from doctors who think they are economists or, worse, professional managers.

  4. Bert Loftman says:

    Interesting article. I expect his thoughts have progressed from complaining about the problems in the book to actually seeing a solution with Medical Savings Accounts that spare health care from the income tax. My progression has been one step farther to solving the problem by repealing the 16th, Income Tax, Amendment as health care reform.

  5. Uwe Reinhardt says:

    “Also, to reduce paperwork Carson would have all payers pay all providers the exact same rate, regardless of their skills or underlying expenses. And he would require all insurers to “become non-profit service organizations with standardized, regulated profit margins.”

    Give John Goodman a fistful of TUMS. He will need them

  6. Uwe Reinhardt says:

    I hope any deposits made into the HSAs by the family would not be tax deductible.

    I don’t think that would square with the religion Dr. Carlson professes.

  7. Charlie Bond says:

    Hi John,

    I just spoke at a fraud convention–well, actually it was an anti-fraud convention. Your remarks regarding fraud are well taken. However, there is real organized crime out there. Who wouldn’t expect it when health care is nearly one in five dollars in our economy?

    Law enforcement is understaffed and under-budgeted to take on the real fraudsters, so resources are spent on the “smaller cases”–what you describe as billing disputes.

    Big insurance companies don’t fight fraud seriously because they are always looking to underwrite the next quarter; seldom do they go after the money they’ve already lost because they have already underwritten for that loss. And the insurers are irrationally afraid of being sued. The sleeping giant needs to awake. Fraud units in health insurance companies and health plans can and should be a profit center for the carrier. Insurance fraud units cannot only fight fraud, but return money to the bottom line, increasing profit for the company and eventually lowering premiums for the consumer.

    Health care fraud is estimated by the FBI to be $100 Billion/year. Insiders think it is more like $250 Billion annually. If we could save that, we would go a long way toward making health care more affordable and, on the government side, reducing our national deficit and state spending on care.

    One feature of the HCA is that it made it easier for prosecutors and insurance companies and everyday citizens to fight health care fraud. All they need is the courage to do so. While our law firm helps doctors, such as the one you describe who are wrongly accused of fraud, we also help those whistleblowers who have the courage bring qui tam suits to fight fraud. Such suits seek restitution of monies wrongly drained from our health care system. These suits are an important tool in fighting fraud and their power has been expanded significantly in the last few years.

    Often health care integration is touted as a path to savings and elimination of fraud. This is not always true. As more and more integration occurs in health care delivery, costs continue to rise and waste continues to multiply. With more unified control in integrated systems comes a greater power to manipulate the system to maximize billings. Those involved in health care scams are more shielded by the new order.

    The phenomenon we are seeing is that insiders are increasingly willing to blow the whistle, especially when providers put profits above patient interests. Whether they are do-gooders or disgruntled employees, these potential informants are more and more pervasive and are is creating a new awareness and sensitivity to fraud in our health delivery systems. It is a growth area in risk management. Often, however, the risk is managed by figuring out how not to get caught, rather than how not to commit fraud.

    Qui tam suits will help clean up the industry, and fear of such suits may alter fraudulent behavior, but the better path, of course, would be for providers to treat their care of patients as a stewardship, not only of the patient’s well-being, but of the patient’s resources. That, of course, can only occur when we have cost-based pricing, which, in the end, would be the greatest deterrent to fraud.
    Cheers,
    Charlie Bond

  8. Ed Chory says:

    Mr Torinus,
    I am a surgeon and I understand your desire to be saved from doctors who think they are economists but someone needs to save the doctors from the politicians and economists and wonks who think they know what they are doing while they try to fix the mess that is American Health Care so there will be doctors to save you and your loved ones when they suffer life threatening injuries or illness.

  9. Roger Waters says:

    Greg,

    Excellent article, and thank you for the analysis.

    Reading about Ben’s experience reminds me of my time as a clinician in a Community Health Center. There were very many appreciative people, but also many with the entitlement attitude of which Dr. Carson speaks.

    One person in particular stands out, who insisted her children be seen immediately, without an appointment and with no regard that all our exam rooms were already filled and the waiting room was full. The lady was extremely rude and even beligerant, but we decided not to call security. We even hurried to open up another room to get her and her children quickly out of there.

    Somehow she found my home phone number and made life threatening calls, resulting in the need for police protection – another waste of taxpayer dollars, but necessary. This, and many other incidents, resulted in my quitting practice there. I thought it was me, so it is somewhat relieving to see others with the same experience.

    And by the way, you are absolutely correct that Ben should not go into politics. Not only would he be irreversibly assimilated, but this country does not need any more politicians! My suggestion would be to require every Member of Congress to work one month out of the year assisting in an indigent care clinic.

    Again, thank you for your thoughtful commentaries, and keep up the good work!!

  10. @Uwe Reinhart
    “I hope any deposits made into the HSAs by the family would not be tax deductible.”

    That is a feature of my approach.

    I agree with all of Greg’s critiques of all other of Carson’s health policy remarks.

  11. Valerie Rhodes says:

    Thank you for a thoughtful and professional response to Dr. Carson’s book,especially your conclusions. The right,which includes me, is always looking for its savior.I was appalled at the clamoring for him to run for President. We need his voice as a communicator and teacher,not elected official.

  12. Ramesh Chandra says:

    Well people made Carson a hero on one statement. He is so wrong on so many points. Who is supposed to give HSA at birth. Govt? I am appalled at his solutions. HSA , HRA and welfare benefit funds are great ideas and they are already working well for many people.
    Some of the points John brought out need special attention:
    1. Health care companies donot make tons of profit. Just look at their balance sheets.

    Instead demonizing any one segment we need to examine closely the process of health care and the costs.

    The most ideal thing way is:
    Patient information is readily available to Drs office.
    Patient can talk to the Dr via chat after the computer makes patient info. readily available to the Dr.
    Dr will gives the treatment thru phone(or internet), or ask the patient come to the office to see Dr or staff.
    Patient schedules his visit and follows Drs instruction.
    The computer gives a sch of charges to the patient.
    Patient pays for services thru check card as soon as the treatment is done from his/her HSA or HRA account.

    All processing is done by TPA. TPA may use an insurance co. to evaluate care.

    A lot of these practices are being brought to the market already.

    53% of all businesses , unions and state agencies are self-funded. Private exchanges are mush rooming.
    Appointment by demand is already happening. Urgent care clinics and mini-clinics are springing up all over.

    Give capitalism and competition in free society a chance.

    Focus on removing the hurdles , not putting more hurdles and more layers of control.

    I started developing my portals. They will have critical conversations on various topics. Come and participate in them. Just give me another month to start.

    I will have 100s of portals. But you can navigate from rchandra.me
    You can contact me at rc@rchandra.me

    I will be doing an injustice , if i don’et acknowledge the grat work John is doing.

  13. Ramesh Chandra says:

    sorry, misspelling.
    Great work John is doing.

  14. Greg Scandlen says:

    Uwe — of course John Goodman is a big fan of a Roth IRA approach to HSAs. He and I disagree on that — as long employer-provided first dollar coverage is tax free ISTM that HSAs have to be as well, But what do you imagine Dr, Carson’s religion has to do with it?

    Charlie Bond — It was me, not John, responsible for this post. Of course fraud is a huge issue, but I think much less with private plans than for Medicare and Medicaid. It is insane that those programs pay for services never delivered by providers who don’t exist. Basic claims adjudication would prevent a lot of this, but Medicare likes to brag it doesn’t spend much on administration.

  15. Al Baun says:

    It is obvious that Dr. Carson prefers a single-payer system but in lieu of that, and with respect to the PPACA, correct me if I am wrong but:

    1) Aren’t providers free to set any rates or conditions they choose when providing service to uninsured patients? [Free enterprise]

    2) Isn’t it correct that providers, in exchange for larger patient pools, voluntarily agree to the terms, conditions, and payment schedules of Insurance companies and Government agencies?

    3) Is it reasonable to say that Health Savings Accounts (HSA), though a nifty way to dodge taxes and have the government subsidize my health care, do little to deal with current health care costs, availability to the uninsured, or fraud?

    4) Finally, since Obamacare does address fraud, cost inequities from being uninsured, Insurer’s unethical practices, extend the solvency of Medicare, and reduced Government (Tax Payer’s) costs … isn’t it reasonable to assume that the overall dissent against Obamacare lies in Political Power and Protecting Profits.

  16. H. James Prince says:

    I don’t feel comfortable faulting the man for not researching all the ins and outs of healthcare for one chapter in a book concerning the overall state of the American Society.

  17. Rober Depaz says:

    I think we need to take it with a grain of salt and remember that first and foremost this man is an amazing surgeon and that is his primary focus, not health care policy. I don’t like how over-hyped his views get on policy-related discussions.

  18. Peterson says:

    Dr. Carson has a bright future in the GOP!

  19. David Wilson says:

    Dr. Carson is a very good man. Clearly, however, he with the help of others will need to dive more deeply into a carefully crafted policy position that truly empowers the marketplace. I too hope that he elects to stay on the high ground and avoid the deep mud of policy and politics. Your observation on the requirement of moral leadership is right on. It is exciting to hear an intelligent, grounded discussion. Let us all pray that Dr. Carson’s voice is joined by many others, demanding solutions that empower the market and the individual, whole person.

  20. Anthony M says:

    Dr. Carson is an inspirational doctor without a doubt, but I think we should stop scrutinizing his policy ideas since he is a little busier being a surgeon than a policymaker/thinker.

  21. Al says:

    I know of a radiologist that many years ago worked for a hospital and subsequently was salaried. There was a billing dispute that could have been argued against almost any radiologist practicing at a teaching hospital at the time, but they picked one with threats of incarceration for many years or a light sentence just to intimidate the others. I never found out what happened, but intimidation is a major part of the Medicare program.

  22. Al says:

    Uwe you say: “I hope any deposits made into the HSAs by the family would not be tax deductible.”

    Does your feeling about tax deductible health care extend universally? In other words assuming we don’t end up with a nationalized health program are you saying that the best thing would be to end the tax deduction for healthcare?

  23. Greg Scandlen says:

    Al Baun asks — “3) Is it reasonable to say that Health Savings Accounts (HSA), though a nifty way to dodge taxes and have the government subsidize my health care, do little to deal with current health care costs, availability to the uninsured, or fraud?”

    No, this is not reasonable. First, HSAs are no greater a tax dodge than any other kind of coverage. Next, they do a whole lot to reduce health care costs — by 30% according to the Rand Corporation. Third, by lowering costs they help the uninsured quite a bit. Finally, they do a lot to reduce fraud by making the payer and the consumer the same person. Not many of us are willing to pay with our own money for a service we never received, but if it is the insurer’s money we don’t care that much.

  24. David Wilson says:

    John, good seeing you in Houston at the Christus Medicus..Make Straight The Pathway Conference. I agree with the substance of your assessment.

  25. Al Baun says:

    @Greg Scandlen – WRT HSA not being a tax dodge … a couple over 55 can deduct $9,000/year by contributing to an HSA account. In the 35% bracket, that’s a reduction of $3,150 in Federal revenues that will have to be borrowed from China or the Social Security Fund. Since I will eventually spend the money, the Federal Government is subsidizing my health care … at your expense. Yes, tax dodge.

    Also, I still don’t see a correlation between HSAs and reduction in health care costs. Me bartering with a Doctor is not going to bring my costs down to Blue Cross or Medicare rates.

    Lastly, an HSA is the last thing lower income people can afford, therefore not helping them gain coverage.

  26. Greg Scandlen says:

    Al, you really need to become better informed. This blog is loaded with reports on the research about HSAs. I encourage you to look through it.

  27. Wanda J. Jones says:

    Hello Greg, John, Ewe and friends…Two points about costs:

    1) When talking about healthcare costs and prices, just about everyone seems to seek a single solution. And if they can’t think of one, to jump right to single payer. This is lazy thinking that only leads to false solutions that will leave the basic operation of healthcare in place. A different approach to healthcare costs and prices would first, tease out the various sources of cost increases–there will be several hundred. Evaluate them. Then decide which bear creative solutions. Just a high school version of this will reveal the inordinate costs of healthcare staffing, the oser-specifications of much of medical equipment and testing, the inflationary effect of detailed medical mandates and regulation, and the cost of general financial incompetence on the part of not for profit organizations who justify expenditures as being “for the mission.” As no one I have read or heard of has done this work, I only see amateur night at the opera, not to be taken seriously. If you don’t address root causes, they will continue, whether from fraud or just everyday incompetence.

    2. Why is fraud or high costs not a matter of consumer concern? Not only is first dollar coverage a trained expectation that makes the patient turn off any judgement about appropriateness, but a bill from a provider these days, especially a hospital, attempts to reveal only what the insurer paid and what the customer is expected to pay. It does not reveal costs, nor does it provide any guide as to what share of the costs could be attributed to the patient’s own behavior. Just for fun, imagine the wide open eyes of a patient opening a truth-telling billing advance at home after a serious surgery:

    Direct cost of your procedure: $xxxxxx, or X% of the total

    Additional cost of our mark-up $xxxxxx, or X% of the total
    for overhead @ 4.5%

    Additional cost of regulatory $xxxxxx, or X% of the total
    compliance with State and
    Federal laws.

    Additional cost of covering the $xxxxxx, or X% of the total
    under-payments from Medicare
    and Medicaid:

    Additional costs of cash reserves that
    are necessary to protect the organi-
    zation’s $xxxxxx, or X% of the total
    ability to function under new risk
    contracts under the PPACA

    Additional costs of legal assistance for
    assuring full compliance with the 10,000
    pages of PPACA regulations. $xxxxxx, or X% of the total

    Additional costs of defending against
    suits brought by the Department of Justice
    for our having created a healthcare system
    through merger with another provider in
    our region, to have a chance at a reasonably
    sound contract for 500,000 people. $xxxxxx, or X% of the total

    Additional costs from recruiting and
    paying guarantees to physicians to
    replace those lost from our medical staff
    because of cuts in Medicare and
    Medicaid payments, $xxxxxx, or X% of the total

    Additional costs from caring for people
    who caused their own medical problem
    through addictions, risky sports,
    family violence, speeding, and rage. $xxxxxx, or X% of the total

    Total: % for direct care: vs % for all the other stuff.
    Do you want to pay that?”

    Seriously, fellow policy analysts–the problem is not only about tax policy or forms of coverage–it is about the entire scaffolding of our American healthcare system. It galls me that the Obamacare/Congress attitude is, on the one hand–”The healthcare system is the pits,” and on the other “We want to get as many people as possible into it!”

    Just take one little, tiny problem: About 1 in 5 people admitted to hospitals is addicted to drugs or alcohol. These are, of course, socially-acceptable forms of self-medication for people who do not have competent or happy lives. I guess we should be relieved that they are not arming themselves to shoot up theaters. But on the other hand, isn’t the way we subsidize the effects of these addictions a kind of endorsement that these addictions are acceptable? Aren’t these a helluva lot more costly than simple billing fraud?

    As to administrative costs, just wait until all the ACO arrangements are in place; we will really have something to denounce, as the accounting and payment arrangements for these will be superimposed on the existing accounting system, and its newly sanctified electronic medical records programs.

    Instead of just commenting on bad policy, why don’t we have some knock-down and drag-out conferences where we expose the flimsiness of rules made by ignorant lawyers who decided to quit uneconomic practices in the worst social sector of all–the criminal justice system.

    Everyone has some quick and dirty alternative to through out–one they know will never be accepted. I will just add a few to the list:

    1) Rewrite any category of healthcare legislation older than the year 2000, so it Hello Greg, John, Ewe and friends…Two points about costs:

    1) When talking about healthcare costs and prices, just about everyone seems to seek a single solution. And if they can’t think of one, to jump right to single payer. This is lazy thinking that only leads to false solutions that will leave the basic operation of healthcare in place. A different approach to healthcare costs and prices would first, tease out the various sources of cost increases–there will be several hundred. Evaluate them. Then decide which bear creative solutions. Just a high school version of this will reveal the inordinate costs of healthcare staffing, the oser-specifications of much of medical equipment and testing, the inflationary effect of detailed medical mandates and regulation, and the cost of general financial incompetence on the part of not for profit organizations who justify expenditures as being “for the mission.” As no one I have read or heard of has done this work, I only see amateur night at the opera, not to be taken seriously. If you don’t address root causes, they will continue, whether from fraud or just everyday incompetence.

    2. Why is fraud or high costs not a matter of consumer concern? Not only is first dollar coverage a trained expectation that makes the patient turn off any judgement about appropriateness, but a bill from a provider these days, especially a hospital, attempts to reveal only what the insurer paid and what the customer is expected to pay. It does not reveal costs, nor does it provide any guide as to what share of the costs could be attributed to the patient’s own behavior. Just for fun, imagine the wide open eyes of a patient opening a truth-telling billing advance at home after a serious surgery:

    Direct cost of your procedure: $xxxxxx, or X% of the total

    Additional cost of our mark-up $xxxxxx, or X% of the total
    for overhead @ 4.5%

    Additional cost of regulatory $xxxxxx, or X% of the total
    compliance with State and
    Federal laws.

    Additional cost of covering the $xxxxxx, or X% of the total
    under-payments from Medicare
    and Medicaid:

    Additional costs of cash reserves that
    are necessary to protect the organi-
    zation’s $xxxxxx, or X% of the total
    ability to function under new risk
    contracts under the PPACA

    Additional costs of legal assistance for
    assuring full compliance with the 10,000
    pages of PPACA regulations. $xxxxxx, or X% of the total

    Additional costs of defending against
    suits brought by the Department of Justice
    for our having created a healthcare system
    through merger with another provider in
    our region, to have a chance at a reasonably
    sound contract for 500,000 people. $xxxxxx, or X% of the total

    Additional costs from recruiting and
    paying guarantees to physicians to
    replace those lost from our medical staff
    because of cuts in Medicare and
    Medicaid payments, $xxxxxx, or X% of the total

    Additional costs from caring for people
    who caused their own medical problem
    through addictions, risky sports,
    family violence, speeding, and rage. $xxxxxx, or X% of the total

    Total: % for direct care: vs % for all the other stuff.
    Do you want to pay that?”

    Seriously, fellow policy analysts–the problem is not only about tax policy or forms of coverage–it is about the entire scaffolding of our American healthcare system. It galls me that the Obamacare/Congress attitude is, on the one hand–”The healthcare system is the pits,” and on the other “We want to get as many people as possible into it!”

    Just take one little, tiny problem: About 1 in 5 people admitted to hospitals is addicted to drugs or alcohol. These are, of course, socially-acceptable forms of self-medication for people who do not have competent or happy lives. I guess we should be relieved that they are not arming themselves to shoot up theaters. But on the other hand, isn’t the way we subsidize the effects of these addictions a kind of endorsement that these addictions are acceptable? Aren’t these a helluva lot more costly than simple billing fraud?

    As to administrative costs, just wait until all the ACO arrangements are in place; we will really have something to denounce, as the accounting and payment arrangements for these will be superimposed on the existing accounting system, and its newly sanctified electronic medical records programs.

    Instead of just commenting on bad policy, why don’t we have some knock-down and drag-out conferences where we expose the flimsiness of rules made by ignorant lawyers who decided to quit uneconomic practices in the worst social sector of all–the criminal justice system.

    Everyone has some quick and dirty alternative to throw out–one they know will never be accepted. I will just add a few to the list:

    1) Rewrite any category of healthcare legislation older than the year 2000, so it fits 21st Century economics, science, workforce and policy.

    2.) Require knowledge exams for healthcare executives and governing board members with publication of the scores.

    3.) Require every legislator who wants to propose a healthcare law to take graduate school level courses on the topic and assemble an advisory committee to hack and hew every supposedly great idea.

    4.) Meld all professional schools in healthcare so that all of the graduates have a grounding in public health, are trained together in fundamentals of medicine, such as anatomy, germ theory, and brain function; and use case studies to train teams to consider the whole person –beyond any single medical discipline.
    fits 21st Century economics, science, workforce and policy.

    2.) Require knowledge exams for healthcare executives and governing board members with publication of the scores.

    3.) Require every legislator who wants to propose a healthcare law to take graduate school level courses on the topic and assemble an advisory committee to hack and hew every supposedly great idea.

    4.) Meld all professional schools in healthcare so that all of the graduates have a grounding in public health, are trained together in fundamentals of medicine, such as anatomy, germ theory, and brain function; and use case studies to train teams to consider the whole person –beyond any single medical discipline.

    5.) Arrange for primary care via home purchase, so residents can plan what they want, supervise it, change it, and see that it is economical to operate by being volunteers to help their neighbors through illnesses.

    5) Tax consumables that have no food value, beginning with alcohol.

    6) Speed the adoption of new science that cures, instead of only modulates symptoms.

    That–that–that’s all folks.

    Wanda J. Jones, President
    New Century Healthcare Institute
    San Francisco

  28. James R Chaillet, Jr. ,MD says:

    With all the discussion about what the Government should do to make health care better and more affordable and the equal (or in this form more ) discussion about what the government shouldn’t do, I find it interesting that no one can envision (dream or fantasize might be better) a world or society where there is no government involvement at all -either in delivering services or in “financing” them.

    I sure many,if not most people, would consider the idea silly, unrealistic or downright impractical; but, if one looks back on U.S. history there was a long period of time with little or no government involvement. There were the late Eighteen Hundreds and the early Twentieth Century where people paid for their own care or they received it through charity. Many of the early hospitals, good and bad, were founded and run based on the concept of charity.

    Much of early research was done by individuals working with their own resources or being helped by private benefactors.

    Looking at own current situation we see: much if not most health care dollars spend on diseases of , for want of a better term, self abuse -obesity, sedentariness, smoking, drug addiction and the like; a market grossly distorted by third party reimbursements, with charges and prices not at all reflective of costs; to numerous to count opportunities for fraud; and administrative costs that take 10-15 % of the health care dollar.

    I thinks it’s time that health economists, policy wonks, interested physicians and others start to have discussions about a totally private or non governmental health care system (or really non system) if just to see where it leads. It may seem impossible but that only shows a lack of understanding the meaning of possible. It may seem unrealistic but currently we’re not looking at realistic solutions to the problems of lack of access, climbing cost and spotty quality.

    So, what do you think, Dr. Goodman?

  29. Tony Grady says:

    Mr. Scandlen,

    I wanted to comment on this message regarding Dr. Ben Carson’s comments because something became very apparent when I read it. I heard Dr. Carson’s National Prayer Breakfast speech. I’m a fan of his for various reasons. But your analysis regarding his ideas made me realize that often good intentions result in counter productive unintended consequences. Dr. Carson has some great ideas. Developing a practical policy to implement them is much more difficult. After your analysis I realized that one of the key problems in developing a policy is what are the real facts? And once you see them how do you verify them before you make policy. I appreciate the work that your organization accomplishes in enabling citizens like me to understand some of the sublime facts that underline many of the complex problems that we face now as a nation.

  30. Nancy Dalton says:

    Just heard Mark Levine and Hannity both speak highly of him on the radio tonight. He might be a candidate of the future?!

  31. Bob Deuell says:

    Thanks John. It’s nice to know I’m appreciated as I work “in the weeds of public policy and practical politics. “