In response, Dr. James Schroeder wrote the following rebuttal, which appeared in the December 26, 2007 issue:
Here's your prescription
By Dr. James Schroeder
Grand Junction CO, Colorado
December 26, 2007
Dr. Michael Pramenko expressed his health care views via a series of false premises in his Dec. 10 column “Play doctor, help find a cure for health care reform.” Well I don’t just play a doctor, I am one. Allow me to give your readers a healthier perspective by analyzing some of these fallacies individually.
* “Unfortunately, [taking government out of the equation] leaves a significant number of people without health care.”
There is a significant difference between health care coverage and health care delivery. Anyone (including my brother-in-law) can declare “health care coverage for all,” but if they can’t actually deliver services, it is an empty declaration. I know my brother-in-law doesn’t have the wherewithal, and I have my doubts about the government. Taking government out of the equation therefore would merely result in people not having governmental health insurance. We have yet to see in real life a government-run health care system without delays and rationing. The real question is whether more efficient use of health care dollars is achieved by government or by private entities. The other key variable is individual behaviors. How do we motivate individuals to use their primary care physician rather than the ER? Should the government try to modulate individual behavior in our best interests, or should we be responsible for making our own decisions? Dr. Pramenko seems to think that government is better suited to make those decisions by mandating individual purchase of insurance. I disagree.
* “The free market has chosen repeatedly to ignore the problem of the uninsured.”
We do not have a free-market health care system, so this premise is false from the get-go. The main causes for the expense of private insurance are unrelated to the free market. The tax code rules that originally allowed employers to provide health insurance as a tax-free benefit created a deeply entrenched connection between employment and insurance.
This led to employers controlling payroll costs by limiting the selection of plans while the employee was basically removed from the decision-making. It also meant that employees who changed jobs had a gap in coverage.
People who are temporarily between coverage account for about one-third of the total uninsured. Current government mandates force insurance companies to include services such as acupuncture, even if the policyholder has no need or desire for such coverage. Finally, individuals who buy health insurance must do so with post-tax dollars, effectively penalizing them. SOLUTION: We should reduce, not increase, government mandates. We should allow insurers to sell plans that are responsive to the needs of individuals and offer equivalent tax breaks for the individual insurance market. In other words, remove the government and employer from the market transaction between insurance provider and consumer. Wait a minute; that sounds like a free market!
* “We all pay for this unbridled use of the emergency room.”
The fallacy here is not that we all pay. The fallacy is that inappropriate use of the emergency room is because patients cannot access physician offices. The fact of the matter is that EMTALA legislation decrees that hospitals cannot deny emergency treatment on the basis of ability to pay. This has become distorted to mean that nobody can be turned away without fear of steep fines or penalties. Most Medicaid plans do not require a copayment for emergency room use. Thus, the current system actually makes it easier for patients to use the ER (convenient hours and no appointment needed!) for primary care. SOLUTION: We need to revamp EMTALA so that true medical screening can be applied and that patients without emergency conditions can be turned away. This should be a medical decision, not a financial one. Medicaid copayments should be reinstituted to serve as a deterrent for inappropriate ER use.
* “There is agreement on universal coverage, mandates on participation and … essential levels of coverage.”
“One thing is certain: More taxes will be needed ...”
These two comments are laughable. If there is already agreement and certainty in this discussion, the debate would be over. Far from any kind of consensus on health care reform there is ongoing active debate throughout Colorado. Many doctors feel, as I do, that government over-regulation has created a mess that cannot be fixed by expanding the role of government. More taxes are not the solution, but are inevitable if we continue to stumble down the path mapped out by the 208 Commission. The government’s role should be that of referee, not participant. Mandates are the problem, not the solution.
I have dedicated my career to the provision of high-quality medical care for children and truly believe that free market solutions are more sustainable in the long-run and more likely to benefit my grandchildren and yours. This belief is based on my own first-hand experiences in the health care system and my ongoing study of the issues.
Dr. Schroeder is in private practice in Grand Junction specializing in pediatric cardiology. He is a graduate of the University of Colorado and Tulane University School of Medicine. He completed pediatric cardiology training at Denver Children’s Hospital.