The World's Best Medicine...
Throughout the 16 years of my career as a practicing ophthalmologist in Mount Kisco and teaching faculty member at Mount Sinai Hospital, I had the privilege of experiencing first-hand the outstanding quality of American medicine. Our facilities, our array of clinical tools, and the men and women who provide care to our patients are the best in the world.
I will do my utmost to preserve that quality, and to continue to provide Americans with the choice of how and where and from whom they receive their health care.
...Must Not be Replaced by Bad Medicine
The number of uninsured and underinsured Americans is not precisely known; we do know that 80 percent of Americans are satisfied with their current health care, and that most are sympathetic to finding ways to cover the uninsured.
However, to prescribe a massive and costly federal takeover of health care when the overwhelming majority of our citizens prefer to keep what they have now is, simply, bad medicine.
Our Health Care Is Unique in Expectations, Quality, and Cost
The American medical marketplace is unique: our consumers expect to have the best possible care, and they expect it to be delivered in a timely way, with the most modern equipment, procedures, and medications. Our physicians are the hardest-working, most innovative, and most extensively trained; our facilities offer the most up-to-date equipment and services; and our pharmaceutical and device manufacturers invest heavily in research and development to achieve ever greater therapeutic advances.
All of this high quality comes at commensurately high, and rising, cost.
The cost is increased further by a tort system that has made insurance against medical malpractice litigation prohibitively expensive for physicians in high-risk specialties, including obstetrics and neurosurgery. Here in New York State, some obstetrician/gynecologists have stopped doing deliveries because they cannot afford the insurance to cover that aspect of their practices. Surveys of physicians indicate that defensive medicine is widely practiced to avoid lawsuits. unnecessarily driving up the cost of health care.
Nationalized Health Care Is Not the Answer
Increasing access and affordability and reducing the rising costs of health care is best done through the marketplace. With the new health care law recently passed by Congress, employers will lose incentive to offer alternative plans, and the private marketplace will wither away. Health care will effectively be nationalized, and millions of our citizens will lose the choice and quality they currently enjoy.
A public plan would mean unprecedented Federal control of health care, removing it virtually entirely from the marketplace's power to reward innovation and respond to the needs and desires of consumers. Government bureaucracies lack incentive to be efficient or consumer-focused; they lack transparency and accountability; and they are expensive and inefficient.
Statistics are frequently cited regarding the cost-efficiency of Medicare -- but, in fact, the program has been paid for in large measure using the payroll contributions of today's workers, contributions that were supposed to be put in trust for their future use. That's called the "unfunded liability," and it's estimated at nearly $40 trillion dollars.
If the government cannot run Medicare without incurring enormous losses, we can be sure that nationalized health care for all Americans will be a fiscal catastrophe -- and it will necessitate drastic limitations on the care that's provided.
We have the world's smartest medical consumers, hardest-working medical providers, and most vibrant entrepreneurial culture. Together we can preserve the world's best health care system, drive down costs, and increase the availability of health care.
Let the Marketplace Do What Government Bureaucracy Can't
We can achieve the stated goals of the recently passed law, and more, via common-sense, market-based solutions:
1) Increase the availability and affordability of health insurance.
Today in New York State, dozens of mandates regarding what insurance plans must offer means that citizens who do not obtain insurance through their employers typically pay a very high price for their plan. A recent study by the Manhattan Institute's Center for Medical Progress showed that elimination of mandates for community rating (which requires that premiums be uniform regardless of age or gender) and for guaranteed issue (requiring insurers to enroll all applicants regardless of health status) would allow private insurers to offer plans at a much more affordable rate.
Allowing individuals to purchase Health Savings Accounts (HSAs), not currently permitted in New York, would also broaden access, as would substantially reducing the number of mandates detailing what services must be covered by an insurance plan.
Permitting sale of insurance plans across state lines would further enhance affordability. For the small number of people who would find insurance difficult to afford due to chronic illness, a high-risk pool could be funded by a modest subsidy on insurance premiums.
Instituting such market-based reforms nationwide would be the optimal first step to increase availability and affordability of health insurance for Americans who are not covered by their employers or by Medicare or Medicaid. We should also allow small businesses and individuals the same tax benefits on health-plan premiums that are available to those who work for large employers.
2) Reduce the enormous burden of defensive medicine.
There is no reason we cannot immediately institute measures to reform the medical liability system, yet our Congress has done virtually nothing in this regard. Common Good, a non-partisan organization advocating for common-sense legal reform, has proposed several measures that would achieve the crucial goal of protecting patients' best interests while also eliminating the drastic costs that the nation incurs in the existing adversarial liability system. Although the tort system is administered by individual states, change can be facilitated from the federal level by making payment of grants (for Medicaid or other programs) conditional on institution of reforms.
I will work to ensure the passage of these measures:
* establish an expert medical-courts system making findings on an objective, not adversarial, basis; providing rational settlements determined by experts and based on true economic loss; and ensuring accountability for negligent providers;
* allow a Federal "safe harbor" protecting providers from liability if they followed accepted clinical practice guidelines;
* pilot "disclosure-and-offer" programs by liability insurers, for selected cases, offering prompt compensation to patients with adverse outcomes.
3) Research ways of delivering care more effectively at lower cost.
The federally-funded insurance plans, particularly Medicare and Medicaid, have instituted programs to increase efficiency -- at all levels, from expenditure on devices/procedures/drugs/biologics to electronic information technology to administration of benefits--and reduce waste and fraud. The findings of these programs can be applied across the insurance industry.
We should also use tax incentives to encourage programs such as those instituted by Safeway Stores and Whole Foods, which reward health-enhancing behaviors and encourage employees, via health savings accounts and rebates or discounts on premiums, to spend wisely on their health insurance and on their care.