One Size Doesn't Fit All

If you take a look at our highways, you see countless varieties of vehicles cruising around. Whether you're on a motorcycle or driving an 18-wheeler, you're able to get to where you're going, albeit with different costs, degrees of comfort and levels of safety.
Meanwhile, if you look at our housing system, you'll see that some people get shelter in downtown apartments convenient to the glitz of the big city and some live in suburban sprawl far away from the noisy traffic. Others live in massive gated homes with hired help. All of the homes keep people dry at night but some are more comfortable, some are larger and some are closer to the action.
Americans are different and want choices to live their lives in their own way. Whether it's deciding what to drive, where to work or what to eat, they do things how they want to. Healthcare should be no different.
Let's say that three people work at comparable jobs. Andy might love to travel so he'll live in an apartment for 50 weeks out of the year and eat cheerios and hot dogs so that he can live like a king for two weeks in Europe. Beth, though, might eat out three times a week and hit the hottest clubs on the weekend but never travel outside her city. Meanwhile, Chad could put his money in the stock market and retire ten years before Andy or Beth. All three recognize that they have finite resources and they allocate them in different ways. In other words: to each, their own.
Healthcare, though, seems to be an enigma. Politicians portray it in binary - either you have it or you don't. In practice, that's about what it is. Sure, you have some choice about what you're getting, but you have two general options: either get cared for or get nothing. There's no "lite" version and no "limited edition" to choose from. It's strange that Americans who can choose between six different qualities of ketchup don't get the choice between different qualities of anesthesia. Either you're in and you get the best of the best or you're out and you get nothing. Part of this comes from the modern approach to medicine with "standards of care" and "best practices" and some of it comes from the insurance approach to mandated risk sharing.
If you want to get from point A to point B on a highway, you get a vehicle and go. If you want comfort you might choose a Lexus or if price is more of a concern you might choose a Focus. Of course, you also might choose a noisy Harley or a Corvette with rock hard suspension. The latter two won't provide you the comfort of a the former two, but they will provide other things. In healthcare, though, you typically get just a few options such as surgery or pills. Which surgery is decided by your doctor and the way tha it is performed is perscribed by your hosptial. You can't elect to use the same anesthesia methods used in 2003 (out of style) or the surgery bed from 1999 (out dated). If you get the surgery, you're getting top-of-the-line, no-expense-spared surgery - there's no "best care circa 1995 (at half the cost)" option. If you get the pills, you might be able to choose between brand name or generic, but that's about the only choice in quality you get in healthcare. Thanks to the fear of lawsuites constantly changing standards of care and the notion that the best care is the only option, ignoring expense, you actually have very few options with your health. You get the best, or you don't get anything.
The insurance companies aren't helping. Their goal isn't to give you the lowest price, it's to offer a competitive price compared to other companies. There's no Wal-Mart among them. The insurance companies are all about risk sharing and if people are willing to pay their prices to share risk, they have no reason to lower them. Also, since they are risk sharing, they don't care what the bottom line is, as long as the top line is above it. There's no discount insurance agency competing with the top-end ones, so you either pay the big prices or go without.

Gradations of Care

The answer to this is that medicine needs to be like every other aspect of life. There needs to be gradations of care available with gradations of price. People need to be able to purchase what they need at the price they can afford. Some people can't afford to shop at Dolce & Gabanna, but they can afford to buy their clothes at Target, so while they might not reach the pinnacle of fashion in Milan, they do get by. Unfortunately, we currently live in a world where all of our healthcare is provided by the equivalent of Via Montenapoleone.
Providing gradations of care is easier than you think and the system is already partially in place. Just as buying a premade suit and altering it slightly costs a fraction of the price of getting a custom-made suit, we could start by making mostly-premade healthcare. We could buy our prenatals with our tylenol and our flushots with our throat lozenges and administer them to ourselves. We could train technicians that specialize in just one or two surgeries and then are overseen by doctors. We could place healthcare centers staffed by nurses, physician's assistants or nurse practicioners in Wal-Mart and Kroger. We could consult doctors and nurses via webcam. If I can print my pictures in one hour, why can't a phlebotomist draw my blood as I walk into Costco and tell me my potassium and sodium levels as I leave? Heaven forbid I get an MRI taken by some technicians in a store in a strip mall and have the results read by a remote doctor (who could be anywhere in the world) at a fraction of the price of an in-hospital imaging lab. If you want the head of surgery to sew up your finger, you should be able to and you should have to pay for it. But, if you're okay with a nurse giving you a couple of stitches, you should be able to choose that and, thus, choose to pay less.
Do fewer accidents happen and better results occur if you follow extensive protocol with highly-trained staff? Probably. It's also safer to drive a Suburban than an Accord. The safety, though, just isn't worth the higher up-front costs, higher gas costs and aggravation at never fitting into a parking spot for most people. Give me shorter lines, lower prices and almost-as-good care any day of the week. I bet a lot of other people would choose it too.

Solutions to Medical Malpractice Costs in America

The American approach to medical malpractice is odd at best. The general concept is that if a doctor makes a mistake, that doctor is then responsible for any harm that comes to the patient. The actual implementation of the general concept, though, is not so simple.

Let's suppose that Dr. Jane Love is a general surgeon and John Smith is referred to her after he is diagnosed with appendicitis. Mr. Smith agrees to undergo an appendectomy and understands that there are certain risks involved but he also understands the necessity of having his appendix removed. Mr. Smith undergoes the procedure and develops an infection at the site of the surgery. Following two weeks in the hospital, he recovers and then goes to talk to his attorney, Marc Nelson.

For arguments sake, let's say that there are some serious questions about whether or not Dr. Love did everything possible to prevent an infection. Dr. Love did a very good job with the procedure, but it is possible that she could have done something more. There is also evidence that the infection would have resulted no matter what she did. Nobody knows if Dr. Love could have prevented the infection but it is obvious that Mr. Smith suffered greatly, accrued extensive hospital bills and missed considerable amounts of work.

At this point the American malpractice system becomes very convoluted for a number of reasons. I'll just address a few of them:

1. Mr. Nelson could refuse to represent Mr. Smith and (assuming other lawyers do the same), he really can't sue Dr. Love. Whether or not malpractice was performed will not be decided unless a lawyer can be convinced to take up the case.
2. Since Dr. Love followed procedure, she is not under threat of losing her license, she is only under the threat of monetary damages. In this case, "justice" is only about who pays what to whom and who covers the cost of the undesired result.
3. Dr. Love doesn't believe she did anything wrong and she did follow hospital procedure. Regardless of her actions, she will be forced to hire an attorney if Mr. Nelson takes the case, even if it never even progresses to court. She is carrying the entire "risk" of the operation until Mr. Smith drops his claim (through a verdict, settlement or because he doubts he will win).

The major problems arise because it is very difficult to determine fault and causality in malpractice cases. There is rarely a clear-cut line where you can state that because person A did X, person B suffered Y (such has removing the wrong leg). Often, cases simply boil down to a situation where person A expected result X and ended up with result Y. When Y is a bad result, person A expects recompense. Is it justice to assign blame when no obvious blame exists? The American malpractice system operates on the basis that the answer is "yes".

Problems

The first problem with meting out justice in this fashion starts with the hurdles to have your day in court. Since malpractice attorneys generally operate under a contingency-fee basis (where they only get paid if they win - usually a percentage of the total award), they will only take cases that will pay enough to justify their time. Since litigation is expensive (court costs, depositions, travel, expert witnesses, staff, etc.), attorneys first make a business decision about a case before they consider the merits. Is it better to spend $20,000 litigating a case where you have a 25% chance at winning $1 million or to spend that same $20k on a case where you have a 95% chance of winning $30,000? Attorneys will only take cases that will make a return, and they don't really care who wins as long as they win enough to stay in business. An attorney can stay in business if they win one case a year and make $1million on it - losing another 12 wouldn't matter and each of those clients would get absolutely nothing. An individual, of course, could directly pay for litigation out of pocket, but few people have thousands of dollars available to take a case to court and there's no cheaper way to litigate. It would seem odd to have to pay a policeman a $3000 retainer (direct payment option) or else prove to him that you can tell him where the robber is (contingency-fee with a good chance of winning) before he investigates a robbery, but in malpractice law, that's the situation that exists. The entry to the case is based on the whims of the attorneys.


The next problem comes from the idea that justice is comparable to dollars. No matter what happens, Mr. Smith can't undo his time in the hospital, he can only be recompensed for his losses. Dollar values can recompense lost wages and hospital fees, but it is a bad way of compensating for pain and suffering since it doesn't recompense, it only replaces. The idea of monetary damages for suffering boils down to the idea that "because something bad happened to me, somebody should pay me" - it's an untenable position since bad things happen all the time. The idea that "my ex-girlfriend broke my heart and so now I'm going to sue her for all the emotional turmoil I went through" makes no more sense than trying to quantify how much pain is worth in dollar figures. If the ex-girlfriend kept the boyfriend’s car, getting it back is justified, but paying for emotions isn't. Only in the realm of medical malpractice do courts seriously try to repair a broken heart (or, for that matter, a broken leg) with a dollar bill.

The final problem I want to discuss is that once litigation has begun, it carries disparate risks on the opposing sides. In our example, once Mr. Nelson has taken the case, Mr. Smith has no reason not to continue with it since he has no risk of losing and only a risk of gain (Mr. Nelson is operating on a contingency fee basis and is paying all the litigation costs and will only get paid if Mr. Smith does). Dr. Love, though, is forced into a situation where she is only carrying risk. Once Mr. Nelson begins a suit, Dr. Love must hire an attorney to defend her. If the case goes nowhere, she is out the money she paid the attorney. If she loses, she pays her attorney and any damages awarded to Mr. Smith. Additionally, Dr. Love's lawyer has no incentive settle the case early since he will be paid as long as it goes on, often leading to increased litigation costs. Justice, then, cannot be had for Dr. Love, only for Mr. Smith - once he gets a lawyer to take his case (and has jumped the entry barrier) he cannot really lose, he can only gain. No matter what Dr. Love did, even if she was the best doctor ever and did the best job ever, she is going to lose - the only question is to what degree.


Solutions

There are some ways to get around these problems.

To start, we must identify the point of the civil courts - to make whole. If a physician is negligent or inflicts intentional harm, the physician should be punished by losing privileges or licensure from a professional committee or even being punished by the criminal justice system. This should be initiated and governed by the state or licensing committee and not depend on an injured party bringing suit and should not involve any benefit for the injured party. The state or professional committes can use expert panels who can decide whether a physicians actions were correct, honest mistakes or true mistakes that need to be punished. Conversely, the civil side of the law should not be involved in punishment but in restitution and making the injured party whole. Medical malpractice law currently attempts to both benefit the injured and punish the injurer and fails at adequately accomplishing either.


Next, we must continue with efforts to cap pain and suffering. There is no good way to quantify pain and suffering and money does not make up for it. Making someone whole by returning what they lost is appropriate, but paying a speculative amount serves no person other than to punish the offender.

Finally, we must remove the cost of litigation and inherent incentives and disincentives to pursue specific cases. The way to do this would be to eliminate the need to place all the risk on only one party. Why should physicians carry all the risk? While they certainly are involved with healthcare, they definitely aren't the only ones who benefit from their efforts. The risk pool should be shared more broadly and then recovering from that fund should be easier. By eliminating the litigation middle-man, millions of dollars can be saved and injured parties can be compensated much more quickly. I have two, competing suggestions on how to do that:

1. Create an additional insurance that patients can choose to buy (or have their insurance buy) before a specific operation or even just for life in general that is called "bad result insurance" where they will be automatically given money if something bad happens to them. If doctors can insure against future mistakes (medical malpractice insurance), why can’t patients simply elect to insurance against bad results? It would be very simple to pay an extra $100 for a wisdom tooth removal with the understanding that if dry socket resulted any future care would be covered plus you would get an automatic one-time payment of $1000 for pain and discomfort. The types of things that could be insured against are innumerable and the market would dictate who bought what coverage and how much it cost. In this case, risk sharing would be pool everyone who decided to buy insurance.
2. A state-funded entity comparable to workers compensation could be formed where, in the result of a bad result during a medical procedure, a patients losses would be automatically covered. Payments into the fund would automatically be charged for every procedure performed (with rates varying by the risk of complication) and as a general tax on healthcare expenditures. This would result in a risk sharing pool that includes everyone who uses healthcare.

Conclusion

Malpractice expenses can be curbed, but we need to recognize the problems and fix them from the base. Current efforts focus on limiting how much is paid out in damages, but the underlying problem isn’t the amount of the damages physicians have to pay, it’s the process by which those amounts are arrived at. We need to reevaluate our malpractice system and individually focus on the aspects of punishment and restitution. By dividing the two and taking the focus off the inefficient process of litigation we can truly lower the costs of medical malpractice while still making whole the injured and punishing the offender. When we leave all aspects of restitution and punishment in the hands of for-profit attorneys we arrive in the exact position we are in right now.

What The Democrats and Republicans are Missing About Healthcare

Let me briefly summarize the position of both parties relating to healthcare reform. I'm going to be somewhat simplistic, but the problems will soon be apparent.

Democrats:
Healthcare should be available to everyone. A government-run program that competes with the private entities is the best way to afford access to everyone.

Republicans:
Healthcare should be available for everyone to purchase. Private companies operating in true capitalistic fashion offer the best option where the market will determine the prices. A government-run insurance plan will lead to an unequal playing field and the private companies will be run out of business, resulting in only a government-run plan. This will result in government-sanctioned rationing and a limit in individuals' choices.

Both parties:
If the Democrats pass any major bill, they can lay their hats on it and benefit in the 2010 elections. Conversely, if the Republicans can stop any major bill from passing, they will benefit in 2010 by showing how ineffective the democrats are.

The problems with both sides:
The United States spends 17% of its GDP on healthcare. Yearly expenditures are also going up by at a rate of 6.9% a year - double the rate of inflation. NEITHER PARTY HAS ADEQUATELY ADDRESSED HOW TO LOWER THESE COSTS.

Both parties are simply debating who is going to be paying this same amount of money - neither has even discussed a feasible idea of how to lower the actual cost. (Rhetoric about electronic medical records saving us billions is ridiculous and won't be discussed in this blog post). At this point, I don't really care who is paying for healthcare - I want to know why we are paying so much.

Another glaring problem is that neither party actually will refer to "health insurance" as it really is - prepaid healthcare. If we want to discuss coverage, then let's do that, but let's be accurate and avoid the semantic fallacy that both parties are trying to pull. Let me reevaluate each party's postition

• Democrats: If everyone isn't insured they will not be adequately prepared for a health crisis.
• Democratic translation: If you haven't prepaid for your healthcare, then if you need a lot of help in an emergency you won't have already paid for how much you consume.
  

• Republicans: If everyone doesn't compete on a level playing field for insurance, prices will soar or government mandated rationing will result.
• Republican translation: If there's no competition among prepaid healthcare then the cost of prepaid healthcare will go up and/or what's offered on the prepaid menu will decrease.

Once you translate things, so what? I frankly don't care who wins this current argument. Neither side is actually working on making an improvement to the overall system, they're just arguing who gets credit for it. Risk-sharing, cost-cutting, changes in billing, reevaluating care and the overall goal of healthcare are simply being dusted under the mat as these two sides fight for a nearly worthless prize.



Solutions:

We need to actually lower the cost of our healthcare. There are countless ways to do that, but the most important is that we need to either implement true competition in healthcare or else implement some sort of cost-containment.

Here are a few ideas to cut costs.

Increase competition for procedures. Here's a very interesting post about the cost of CT scans in America compared to India. It turns out that for the exact same procedure with comparable equipment can cost 60 times less in India ($6500 compare to $115). It literally would be cheaper to fly to India to get a full-body CT scan (with contrast) and have it performed by a trained radiologist than it would be to get it in the states performed by radiological technician. As it is, there's a waiting list in America to get these procedures done. Why lower the price if there's a line outside your door? If there's only one choice for food in an area, the restaurant can charge whatever they want and people will pay it - ever been to a football game, ski resort or movie theater? Many procedures simply can be performed for less and will be if there is any competition. We need to encourage individual clinics to open up and specialize in offering select services for less and then let the market go to work.

We also need to increase the number of doctors. The US has 2.4 doctors per thousand people, which compares very poorly to Switzerland's 3.8 or Belgium's 4.0. Doctors currently don't have to compete for patients since there's a wait. Why should this one profession be competition free? It definitely isn't going to lead to better care, shorter waits and reduced cost. We need to increase the number of doctors who are trained in the US and make it easier to become a primary care physician. There's no shortage of people who want to practice medicine, just a shortage of programs who will train them.

Also, to cut costs, we must encourage people to live healthier lives. The fact of being unhealthy obviously isn't enough to dissuade many from leading unhealthy lifestyles, so we need to dissuade them in another way. I recommend we tax unhealthy behaviors. Cigarettes, alcohol, potato chips, most fast food and carbonated beverages could all be taxed and the money used to fund medicaid and fund anti-obesity campaigns. We wouldn't be taxing obesity, just the behaviors that are proven to cause it. People need to be spurred into action and since their health isn't enough encouragement, maybe their pocketbook will be.

Finally, to really spend less on healthcare, we actually need to reevaluate how it's provided. The 20th century has had a huge increase in the use of hospitals and hospitals are very expensive to run (thank you, JCAHO). Whenever care can be provided outside of a hospital, it should be. Smaller clinics, home-based care and services provided by non-doctor healthcare providers (nurses, PAs, etc.) should all be used. There's no reason that you need an MD to tell you that you are overweight and should stop smoking - a nurse is more than adequate to provide that important service.


Conclusion:

Health reform is an interesting and necessary topic that needs to be addressed. But, we actually need to address what matters - how to lower the cost we are paying. Right now, the major political parties are fighting for a prize that has no worth.

6 Things To Change in American Healthcare

President Obama recently began to attempt to fulfill his campaign promise to reform healthcare in America. He is being very pragmatic about this and recognizes that people will disagree about what needs to change in America.

I have spent many hours studying different proposals and I've come to the realization that the big issues aren't being discussed, let alone being considered. Both sides seem to be arguing more about minutia rather than what truly matters. To help the process out, here are 6 things that need to change in American healthcare. In conjunction with each point I will ask a probing question that really should be answered.



1. Healthcare should focus on helping patients, not avoiding lawsuits

Billions of dollars are spent every year by the healthcare industry in an attempt to prevent lawsuits. Whether it's striving for a better JCAHO review (a waste of time and money) or simply trying to cover your back by shoving piles of waivers down patient's throats, hospitals, doctors, HMOs and everyone in between often worry about what they have to do to protect themselves rather than to help their patients. Accidents and mistakes should be prevented, but worrying more about preventing a lawsuit rather than delivering quality care. Physicians might be more concerned with an individual patient, but the CEO cares a lot more about a possible tort claim than whether or not Mrs. Jones was pleased with her care.

Question 1: Are malpractice claims intended to help the injured or punish the offender?


2. Efficiency is necessary, even at a cost

The National Highway Safety Traffic Administration estimates that over 40,000 people are killed each year in traffic accidents. That's one out of every 7,500 people in America die every year just from traffic accidents. On top of that, roughly 2.5 million are injured by motor vehicles each year. That's one out every 120 people. How could we reduce these numbers? Simple - we just put a governor at 15 miles per hour on every vehicle in the country. Why won't that happen any time soon? That's also simple - the number of lives we save and injuries we prevent aren't worth the efficiency it costs.

Healthcare is in much the same boat except coming in the other direction. Rather than focusing on ways to make things more efficient and more cost effective, we focus on how to save that one more person. The American Cancer Society estimates that 565,650 people died from cancer in 2008. Of that number, 1/3 of the deaths are attributable to obesity/nutrition (188,500) and 170,000 can be attributable to smoking. Meanwhile, 49,960 deaths are attributable to colorectal cancer. They recommend, though, that after the age of 50 people get a flexible sigmoidoscopy every 5 years and a colonoscopy every 10 years. The average colonoscopy costs $3,081 while the average diagnosis of "obese" or "smoker" is free. Efficiency demands that we first focus on the bigger, more cost-effective diagnoses.

Don't get me wrong, I'm not against regular colonoscopies (there is, after all, a 5.4% chance that everyone will get colorectal cancer in their lifetime). What I'm using this example to illustrate is that we need to be efficient with our resources. Rather than using a new screening method that is 99.9% effective at detecting some rare disease, why not use the much cheaper 97% effective screening method? Will we miss some cases that we otherwise would have found? Yes. Will we save vast amounts of money? Yes. Healthcare shouldn't be confined to 15 mph - we need to make the changes that make us efficient, recognizing that there is a price that we will have to pay.

Question 2: How much risk are we willing to pool as a society?


3. Not all ailments can or should be treated

Americans love stories of underdogs who overcome long odds. While these tales make great stories, they make lousy justification for policy. When a patient spends the last days of their life in the ICU as opposed to at home with family, they may live a few days longer, but they also will pile up huge costs. A 2005 study (based on data gathered in from 2002) estimates the daily cost of a patient on ventilation in an ICU to be $10,794. That means that prolonging life by a few days costs huge amounts of money. I know I value my life, but if someone offered me $10,000 to give up next Tuesday, I'm pretty sure I would take them up on the offer - and that's not even an end of life sick day.

It may seem callous, but we cannot use insurance (cost/risk sharing) to try and work miracles. Hospice/palliative care must be viewed as a viable option. Medicine cannot simply be focused on delaying death but also maximizing life. Two weeks in the ICU compared to one week at home shouldn't be viewed as a tough choice to make by a care provider.

To accomplish this, there needs to be a standard set about what kind of care we are willing to risk share - the debate about what that is can then follow.. Is it that there must be a 50% chance of survival for two weeks and a 10% chance of survival at one year to warrant extraordinary care or is it lower than that? We cannot say that a 1% chance of survival beyond two weeks and a 0% chance survival at one year is worth $10,000 a day for the next week. People can still choose to pay for whatever care they want out of their own pockets, but risk sharing extraordinary care is untenable.

Question 3: What is the dollar value of a day of human life?


4. The federal government cannot make specific decisions about quality of care

Healthcare is a local concern. New Yorkers don't care about how rural doctors are able to get to remote communities any more than Alaskan Inuits care about whether or not a New Yorker has to go all the way from the Bronx to Brooklyn for an MRI (even after a 3 month wait!). The issues affecting each community need to be addressed by that community. Standards of care, expectations and willingness to pay all vary by location, culture and geography. These communities need to make their own decisions about what is expected and what can be afforded. Just as people make decisions about where to live, they also need to make decisions about what they want to pay for. New York offers everything from the arts to Wall Street and every service (including world-class medical care) in between. It also offers crowds, congestion, pollution and crime. Ashley, North Dakota might not have Broadway, but it can offer clean air, open spaces and much cheaper housing. Putting a New York standard of care on Ashley makes as much sense as putting an Ashley pollution requirement on New York.

Whether healthcare is administered via the government or through private insurers, the issue still remains what must be covered. If we have a federally mandated level of care, why should New Yorkers have any say in deciding how many MRI machines are enough for Ashley, ND? In New York, MRI machines per population might be the way to go. In North Dakota, distance might be the more important factor. Additionally, the administration needs to be local. A senator from New England who has never ventured west of the Mississippi has no more business telling North Dakota how to care for their sick than a North Dakota farmer has in telling New York what to do. They come from different backgrounds and are concerned with different things.

If the federal government wants to mandate that everyone is covered to some extent, that's fine, but it CANNOT try to oversee things. Primary care for the implementation of any standards has to be done on a more local level. Whether that is state-wide or smaller can be debated, but the federal government needs to keep its hands to itself.

Question 4: Who should make decision about which risks are shared?


5. People are responsible for their own choices

America is based on a system of rights and responsibilities. I have the right to vote, but I also have the responsibility to get myself to the polling station and make an informed decision. I have the right to choose to have children and I have the responsibility to provide and care for those children.

Healthcare is the same situation. It has been determined (I still wonder who made this decision) that people who need emergency healthcare cannot be turned away. This leads to the underinsured and uninsured flocking to emergency rooms for minor care. The cost of their care then goes to everyone else. Whether the solution is requiring everyone to be insured, creating a national healthcare plan (similar to our school systems where everyone can go) or if it's by somehow really holding people individually responsible for the price of the care they receive is up for debate. What shouldn't be debated, though, is that people need to be held responsible for the decisions they make.

Specifically, we know that certain choices (not genetic disorders) contribute to many diseases. Each year roughly 440,000 die from smoking. Their healthcare costs are a result of the decisions they made over the course of many years. Why should they only contribute the same amount to the risk pool when they are choosing to put themselves more at risk? Because of their choices, they should be contributing to healthcare more than those who aren't making those choices - let the penalty fit the crime. This can easily be implemented by raising taxes on products that are known to cause health problems: alcohol, tobacco, sugary drinks, many fast foods and most candy, just for starters, can be taxed (ideally at a state level) which an then go directly to the healthcare fund. An occasional Big-Mac probably isn't going to hurt you and neither will paying an occasional tax when you buy one. Eating them daily, though, will add up for your health and for your health plan.

Question 5: Should people pay for the benefits they receive?


6. A doctor at a hospital isn't always the best choice

When there is a health emergency, Americans instinctively think about going to the hospital to talk to a doctor. While in many cases this is a good idea, in other cases it really isn't necessary. Why does an MD need to sew up a cut finger or set a broken arm?

A doctor spends many years studying to learn to diagnose. Treatment, often, can be done by anybody with moderate training. While it might take a specialist to decide what drug cocktail is needed to treat a certain ailment, any nurse can administer the IV and any nurse's assistant can hand the patient the right pills. While it is true that certain procedures require specialized training, many (probably most) do not. You can get your eyes checked at Wal-Mart, why not get your stitches there, too? All we need to do is to change the definition of practicing medicine and then allow less-skilled diagnosticians to treat patients for less.

Question: Is a hospital an ideal setting to receive treatment?