The administration made an important speech to the AMA recently about the health care reform debate. I'd like to take the arguments presented in it one at a time. I think one of the major points of the plan being presented is the public insurance option. Obama says that we need a public option for more choice in health insurance. It's not too difficult to see why that argument resonates. Most of us have little choice in which plan we have. Our employer picks our options, and in many cases has only 2 or 3 plans to choose from. Most of the options are from the same 2 companies. In my area, 2 insurance companies have 80% of the insureds. So clearly a lot of us feel we need more choices. But why is our choice so limited? First, why should my employer have any say in the insurance I have? That was born of a previous period of salary caps when "benefits" was the only way to raise pay for workers you needed as a company. It's way past time to change the tax laws so that there is no reason for employers to be involved in insurance decisions. But that still leaves me with only 3 plans to choose from. Why is that? There are over a thousand companies offering insurance in this country. State laws keep me from shopping for insurance across state lines. State laws also mandate what "must" be included in a policy. The effect is to limit my choices. Why not open up competition by eliminating these restrictions? There is no reason for me to buy a policy that covers chiropractic for example, because I'll never use it. But it's been placed in many state requirements. Let the companies and the states involved offer policies tailored to choice. How about a low-tort option like the car insurances offer? I'd sign on for that. Just limiting pain and suffering to $250000 makes a huge difference in malpractice premiums, so let me choose that option to lower my premiums. How about an option to lower premiums by refusing second opinions? Not sure I would sign that, but it should be an option. I don't need insurance that covers maternity anymore. THAT should lower premiums a lot. How much am I willing to pay in co-pays to lower my premium? That would increase more responsible use of services. How about discounts for exercising regularly? I'd sign that one! Nothing like my pocket book to encourage good behavior. This would be real choice. The public option would be a false choice that would end up by limiting all our options. Who would it really benefit?

I keep hearing that the most expensive, inefficient way of providing health care is through our emergency rooms, so that is why we need universal health care. Has no one noticed that our Medicaid population does just that?! Our ER sees patients for colds, hangnails, dental cavities, and bugbites on a regular basis. These patients aren't there because they don't have insurance; they are all covered, and have assigned primary care physicians. They are there, because we don't require an appointment, and we are open 24 hours, and there is no reason NOT to use us. Does anyone really believe that having universal health care will DECREASE the amount of patients using the ER unnecessarily?

Does anyone remember when HMO's first came in? Yes, I'm old enough to remember when they started. There was a study that showed that when you had an HMO, you were 25% more likely to see a doctor. I remember being shocked that it was so low, because my experience was that it was WAY more likely than if you had to pay full price for an office visit. Parents would bring in their children for me to "just check their ears and make sure they're all right for our trip", or "he woke up crying today, and he doesn't usually do that". Then throw $3 in change at the clerk at the desk. Certainly that made it harder for us to give appointments for the children who were actually sick. Now imagine that attitude and that behavior magnified 100X for a nationalized health care system. If it's on the government's dime if you need to see a doctor, what is the barrier? It may end up being the availability of the doctor. Will medicine be overwhelmed by the banal and the impatient? And who decides? Not the doctors, and not the patient......so who?