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In North America, many people get their health insurance as a benefit provided by their employer. From 2007 to 2008, the average portion of health care claim costs attributed by insurance companies to employers doubled to $1000. This portion is called a deductible (in the UK it is called the excess).

The media has underreported the fact that the recently enacted healthcare law has seriously weakened what is potentially the most effective method of both reducing the cost of healthcare and encouraging those without insurance to become insured—the health savings account (HSA) and similar iterations such as the flexible savings account.

By reducing the tax deductible cap on HSAs from $6150 per year by $3650 per year, the government seems poised to dismantle them; this is a mistake, because HSAs incentivize people to conserve their health care dollars.

Polls have shown that while 70% of the public favored the concept of health care reform, 60% opposed the bill that was enacted. The opposition was multi-faceted. States objected to the costs that would be forced upon them. Many seniors concluded that the elimination of Medicare Advantage would transfer costs from the government to seniors rather than actually reduce the cost of care. They also worried that the scheduled cuts to basic Medicare would result in a reduction in their quality of care. Many economists opposed the bill because they expected it to result in a deficit instead of the 140 billion surplus that had been predicted by the Congressional Budget Office (CBO) on the basis of the assumptions provided by the Congress.

Now that the broad outlines of the healthcare bill are known, the public needs to look beyond the rosy characterizations by the left and the dire predictions of the right and try to discern the facts.

Clearly the 140 billion dollars in deficit reduction is a fiction that relies on Medicare cuts that Congress has never had the will to achieve in the past, a 200 billion cut to physicians that Congress has already agreed to restore, giving 6 years of benefits while taxing for ten, and double counting savings.

If the legislation passes, the approaches that are being relied on will aggravate rather than reduce cost. Initially, we will see a few benefits in senior drug costs, the ability to keep children on coverage, limitations on policy cancellation, and guaranteed (but very expensive) individual coverage. In four years, after the next presidential term, after many of the Senators and Congressmen who voted for the current legislation have become well-paid lobbyists, and after the uninsured begin to be added to the rolls, expect costs to soar.

If problematic gamblers have more health care problems than non-gamblers, why are some experts supporting a national lottery system to pay for universal health care? Two wrongs do not make a right.

In 2007, Senator Obama said that we are “not going to pass universal healthcare with a 50 plus one strategy”. Now this strategy, known as reconciliation, threatens to overcome the protections of filibuster.

The public’s desire to eliminate unwanted insurance practices should not be used as an excuse to force through legislation that is definitely controversial and probably deleterious.

If the only applicants for individually-purchased health insurance policies were average-risk individuals who had lost their job and their insurance, rate increases in California would have been average. However, the guarantee of insurance attracted high-risk individuals. Costs, and premiums, increased exponentially as more of these individuals joined the individual policy market. As premiums increased, low-risk, between-jobs individuals who didn't want to pay the premium opted out, thereby creating a vicious cycle of escalation. Government exacerbated the problem rather than solving it.

In his State of the Union speech, many of the statements President Obama made about the pending health care legislation were at variance with the facts.

The most egregious comment he made was his statement that the non-partisan Congressional Budget Office (CBO) found that the legislation would reduce the deficit by one trillion dollars over 20 years.

Exchanges are being promoted as a method of lowering the cost of healthcare by 1) using regulation to force insurers to limit the cost of administration, 2) possibly limiting the compensation paid to executives, 3) creating competition that will force insurers to minimize profits, 4) providing guidelines and payment schedules that will cause physicians and hospitals to choose the most cost-effective care rather than the most profitable care.

Unfortunately, we know how the movie ends. Collectivizing farms in China and Russia led to famines. Cities with strict rent controls end up with acres of slums as landlords can no longer afford to keep up their properties. Price controls on oil in the 1970’s led to long lines as gas shortages developed.

Be careful what you wish for—you may get it. Surveys indicated that healthcare reform was usually only 4th or 5th on the public wish list but for those who listed it, the high cost of care and the possibility of being denied insurance were highly important. Politicians seized on this concern and used the vilification of insurers to promote the belief that increased government involvement in healthcare would lower the cost of care while improving quality. The recent Senate bill is an indication that the exact opposite will occur.

The new legislation will force us to spend an extra 2.4 trillion for ‘universal’ coverage when we could have limited coverage to the truly underserved and spent only 375 billion.

Early this year, 60% of the public supported healthcare reform. The latest polls show that support for the current proposals is now below 40%. Among those who are more informed on the subject, the level of support is even lower. Why is public support falling and why does Congress persist in trying to pass an unpopular proposal?
New legislation is generally supported if it can be demonstrated that it will provide a benefit that exceeds the projected cost. Benefits are expected to supplement or improve on existing ones rather than to eliminate a benefit for one group in order to provide a benefit elsewhere. The bills currently being considered fail these standards.

The public, with good reason, is now firmly against both a Canadian/British style single payer approach to reform, and the American counterpart, the introduction of a public option insurance system intended to compete with private insurers and cause them to lower their charges. Rather than accept the public’s clear-cut opposition to this approach, Congress is trying to circumvent the public will by expanding Medicare to portions of the 55-64 age group and by creating a privately run public option. This approach ignores the fact that Congressional proposals are opposed because of a basic distrust of government run medicine and the high cost of proposed changes rather than because of disagreements as to the method of takeover.

The “public option” is being presented as an absolute necessity if the cost of healthcare is to be reduced. In brief, proponents of this approach state that a government managed insurance program can substantially lower the cost of a healthcare policy because a) it will not be subject to the high overhead and high profits of private health insurers, and b) the presence of this low-cost alternative will create competition that will force private insurers to lower their profit margin and the cost of their policies. The data that has been cited in support of this position have not been accurate. Many countries have turned to government ownership of steel, banks, oil, or other industries in an effort to minimize the profits gained by individuals and thereby lower the costs paid by the public. However, the worldwide trend in these countries has been towards substituting the flaws of private ownership (and there are many) for the negatives inherent in governmental inefficiencies and political distortions.

Instead of proposing a 2000 page all-inclusive bill, Congress should craft legislation that encompasses the most important aspects of healthcare reform and can be agreed on by both parties. Each political party will be less likely to object to the changes proposed by the opposing party if the extreme components of proposals are removed, the best of the ideas from both parties are incorporated into the bills, and the concerns of the various stakeholders are addressed.

Congress is asking the U.S. public to believe things about healthcare ‘reform’ that defy common sense (unless you believe in the Ponzi school of economics). A Ponzi scheme promises unbelievably large returns on your money but invariably goes bankrupt when the public catches on and refuses to continue pouring good money after bad. The financier Bernie Madoff was the last example of a large Ponzi scheme and ‘reform’ may be the next example if Congress tries to provide comprehensive coverage for the uninsured today while hiding the true cost until tomorrow by a) billing us now but withholding benefits for six years and b) overestimating ‘savings’.

Dr. Roger Forsyth explains how a Single Payer System might work in the US but that it is folly to assume that the implementation of such a system would automatically reduce costs.

He writes "It is cost that is causing bankruptcies, loss of insurance, and the inability to purchase insurance. Yet rather than addressing the root cause of the escalation in cost (the overuse of services) in a disciplined manner, the bills adopt a shotgun approach and expand coverage to the uninsured, create new entitlements, add new expenditures, and then add new taxes, fees, and penalties to pay for the additions. When it comes to true cost containment, there are only vague programs that the Congressional Budget Office cannot certify as being capable of saving money....

There is nothing in the history of Medicare and Medicaid that would justify the assumption that government ownership is cost-effective...The concepts of universal coverage, community rating, and low-income subsidies are all good, but we should not put the cart (a reduction in the uninsured) before the horse (a reduction in utilization)."

Dr. Forsyth makes a clear argument for aligning the incentives of patients and payors using an eight part plan, which would include making health insurance mandatory, using a community rating instead of charging more for different people, splitting a comprehensive insurance policy into two (one for primary/preventive care and one for catastrophic illness), providing a means for health insurance to be purchased with pre-tax dollars, requiring substantial deductibles and co-pays of patients to discourage care of marginal value, among others. We think his proposal is right on the mark. See what you think.

Roger A. Forsyth, MD is a retired family practitioner who currently teaches at the University of Southern California.

The US healthcare system supports far more specialists than Canada. This differences alone could add 40% to the cost of physicians care compared to Canada.

Dr. Forsyth thinks that shielding patients from paying for outpatient and office visits, especially for specialty care, has contributed greatly to increasing healthcare costs.

His important insights into where healthcare reform has been can help better focus our question: where should we go now?

On a conference call with members of the White House Office of Health Reform, nearly 2700 physicians from around the country were reassured that much healthcare savings will be found "in our own backyard". When Dr. Stuart Glassman, a primary care physician from Massachusetts asked if there was any plan to move to a national global payment system, his question was not directly addressed. That was a good move, because enacting a global payment system would pitch doctors against patients in the quest for resources. And no one wants that.

It can’t be much fun to be the first smoking US president in decades. We've heard that President Obama is having trouble quitting his tobacco habit. It may be related to the color of his skin.

No, really.

Melanin binds nicotine, and having darker skin color is associated with having a stronger addiction to nicotine. African Americans have a lower quit rate than caucasians, but, among heavy smokers, have a higher risk of lung cancer. Time to pull out the next quit strategy.

Exercise is not easy for women in Saudi Arabia. Not only are licensed women-only gyms scarce, but even walking in public is proscribed without being accompanied by an adult male relative. The decision to ban unlicensed women's gyms will place Saudi Arabia's already obese population at increased risk.

New York City Healthcare Commissioner Dr. Thomas Frieden and colleague Kelley D. Brownell support New York Governor David Paterson’s now-dropped proposal for a soda tax,the New York Times reports. The Soda Tax, favored as a way to increase profits and reduce obesity, is modeled on the Tobacco Tax, which has reduce smoking and raised money for healthcare for those with tobacco-related illness. Are sugary soft drinks the only culprit here? Raising prices and cutting calories may not be enough.

President Barack Obama praised the nursing care his daughter Sasha received when she was evaluated for meningitis as an infant, saying that nurses are the backbone of healthcare, in comments at a virtual town hall meeting at the White House on March 26th, 2009. Obama is correct that nurses play a vital role in patients’ healthcare; nurses deliver the bulk of bedside care in hospitals. President Obama is to be commended for finding the backbone of healthcare in nurses. Let's hope he does not forget about the rest of the anatomy. Every member of the health care system plays a role in the care of individual patients, even if that care is not obvious to patients.

The battle against polio in Pakistan has been hampered by poor vaccination strategy by the World Health Organization (WHO) and military activity in northwestern Pakistan, the IPS reports. Prof Abdul Hameed, president of The Pakistan Pediatric Association (PPA), charges that the WHO did not seek the assistance of the PPA, and did not administer a sufficiently broad type of vaccine.

If money buys happiness, then sadness, apparently, spends it. In a report in the Journal of Psychological Science, Cryder et al found that sad individuals who are self-focused will spend more money than those who are not so self-focused.

Near the top of the list of Things We Take for Granted: showers (15-20 gallons of water per shower), and indoor plumbing (25 gallons of toilet water per person per day). Where water isn’t plentiful, unrestricted and cheap, where there isn’t even enough clean water to drink, countless thousands of human lives are in jeopardy.