Retired Doctor Devises Plan to Cure Health Care

Casting aside the unfortunates forced to wait until their health problems warrant emergency-room care, how does our medical system work for the rest? Well, not so well that most Americans aren't in favor of a change. According to the Kaiser Health Tracking Poll, the public rates health care as the second "most important problem for the government to address," behind Iraq but well ahead of the economy. "In some ways, it may be the key domestic issue," concurs Gallup. "Americans apparently have a great fear of being faced with huge medical bills they are unable to pay."

This fear has been fanned by the rapidly escalating direct medical costs to those lucky enough to have insurance through an employer. According to the Kaiser Family Foundation's annual benefits survey, the average employee premium contribution for a family coverage plan has risen to $273 a month from $129 in 1999. Add in the deductibles and co-pays, and the pocketbook drain looks even worse.

Fortunately, we've developed something of a national consensus on how to tackle such ills: We want the uninsured covered and for the rest of us to pay less while getting more. The government should engineer this miracle without taking over in the process. And businesses should pick up the tab without outsourcing our jobs.

The real problem is that we can't afford to give everyone the sort of care many of us would want, and can't admit to ourselves that we can't afford an unlimited supply of medical services. We are, after all, the richest, most blessed and most incurably optimistic nation on Earth. Our regard of individual worth is matched only by our faith in scientific progress. Even creationists insist on the latest scans for themselves and long-term life support for the brain dead, by God.

And yet available medical resources are sadly finite, despite the fact that health care already consumes an ungodly 16% of the U.S. gross domestic product. (Those pitiful Europeans pay less, often live longer and are no more dissatisfied with their system than we are with ours, but never mind.) Like any limited resource, medicine must be rationed by access or price. But since we tend to block out this painful fact, we've escaped the uncomfortable choices by subcontracting the job to Medicare, emergency rooms and HMOs, on the condition that they ration covertly, out of sight.

"Fixing American Healthcare — Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare" is not the catchiest title in the world. Maybe the good doctor should have gone with "10 Reasons to Distrust Your Physician" or "Health Emergency: A Medical System on the Brink." Regardless, this is a survival guide every patient deserves. If you don't want to buy the book, a lot of the material is reprised on Dr. Rich's promotional site, which also links to his Covert Rationing blog.

Conspiracy theorists and ideologues might be disappointed. Dr. Rich doesn't believe that covert rationing is any kind of plot, nor does he deny the benefits of managed care or the necessity of policing fraud. He does have two big bones to pick with the current system. One is that it's less efficient than public decision-making would be, since covert limits rely on opaque regulations and bureaucracies motivated in reverse. Worse, Fogoros says, covert rationing corrodes the very foundation of medicine — the doctor-patient relationship — by turning the physician into an agent of the government or, increasingly, a business partner or employee of the HMO.