The Arkava Soution to our Health Care Crisis.

No one is more attuned to the heath crisis in the United States more than the providers of that care. This issue has come to the forefront in the last 5 or so election cycles. Of course, little has changed. The problem in a nutshell is that, for many reasons, health care is expensive. The costs are so prohibitive that people cannot afford health care without "health insurance". Most data cite that about 50 million American citizens are uninsured.

So the problem is this: How to get more Americans health care?
A popular democratic solution is Universal Health Care, which many see as a single payer system administered by Uncle Sam.
The popular republican is answer is a free market solution. Which is basically gives citizens tax incentives so that they can buy private insurance. This plan attempts to create a competitive market that will drive health insurance premiums down.

While opinions vary, most providers favor the free market system. We have already tasted the bureaucracy of Medicare and Medicaid. Many doctors already cap their practice with respect to the number of patients they will take with these plans. However a growing minority are supporting Universal Care, essentially saying something is better than nothing.
Recently, in one of our monthly journals, an editorial was written by a supporter of Universal Health Care. I have the great honor of working with a physician who wrote a response to this editorial. Todd Arkava MD is a fellow ED doc who sees the health care crisis daily. He is compassionate, empathetic and always acts in the best interest of the patient no matter their "insurance status". He served in Iraq and is now a retired officer from the United States Army. So when Doctor Arkava speaks of duty, service and citizenship, few physicians can match his qualifications. His rebuttal was so excellent, I have included it here for your review.

Dear Editor:
I want to comment on Dr Hockfield’s article on health care reform, as I see some major flaws with his reasoning. I think the problem that most people have when trying to solve the high cost of health care in this country is that they have trouble stepping outside of the current paradigm. Free market health care would not work with the current system, but where is it written that the system has to be the same?

First of all, people do not have a right to health care. Dr Hockfield claims that "access to basic health care is a right," but then goes on to say that certain physician services are included in that right. There is no way that a person can have a right that infringes on the rights of other people. These are called positive rights, and are morally flawed. A person can have a negative right- the right to be free from harm by another person, but health care requires that other people provide goods and services. If I have a right to health care, the doctors, nurses, pharmacies, and drug companies will have to give me their product and service for free, which infringes on their right to be compensated for their labor. What do you want to do to people who refuse to give away their work for free? Steal money from them in fines? Put them in a cage? Once you force someone to work for free, that person has become a slave, which is prohibited by our Constitution.

Claiming that people should have a right to health care is akin to saying people should have a right to food and therefore all restaurants and grocery stores must give their products and services away for free. Is the government going to pay for these things? How will they ration those dollars and determine who is deserving? Will they also throw money at another commission with a top-heavy bureaucracy? What if a physician does not want that money with all those strings attached? Is he or she free to make those decisions, or is the doctor forced to provide that service on penalty of being fined or jailed? The socialist system cannot work without threats of violence. Am I the only one who finds that troublesome?

Dr Hockfield makes the argument that the suppliers of health care have too much control over the demand. I agree with him, and this is where the free market could take over. Why does it cost $800 for someone to come to the ER for an uncomplicated broken arm or laceration repair? Why can’t someone spend 6 months to be trained in simple procedures and make a living in his or her own private clinic? No, there is no medical degree being given, but they can let the free market determine if they are doing a good job. They have a great incentive in that they will go out of business if they do shoddy work. Before you suggest a regulatory body to oversee this industry, think about how much the costs will go up to fund the bureaucrats in this endeavor. We are trying to keep costs down, and the free market is very good at that job. I am sure these people would be happy to receive $50 for minor cuts and breaks, and they could even use dangerous drugs like: lidocaine, tetanus boosters, and cephalexin.

We have a monopoly on services in this industry, and the free market cannot exist without competition. What would hospitals do to compete with this new sector? They would have to lower prices. If a person wanted a thorough physician evaluation, he or she could choose to pay more. Much in the same way you decide what to eat for dinner or what type of television to buy, cost plays a role. People make decisions about their health based on cost all the time (types of food, cigarettes, alcohol, saturated fats, etc).

Pharmaceutical companies are also hampered by FDA restrictions, which make them take almost 20 years to get a new drug approved. They in turn have to charge ridiculous amounts of money for their product to recoup these costs and strategically hold off on releasing medications until they have exhausted the prior one. For those of you who will argue that this is for safety, I urge you to look at the number of drugs that came to market and were later found to be extremely harmful. What is wrong with publishing data and allowing physicians and patients to decide? Are we too stupid to make those decisions? How long would a drug company be in business if they produced a drug that harmed many people? No one would buy their product and the owner could be held liable in court as well. When was the last time a member of the FDA got sued for approving a drug that was harmful?

Finally, on the issue of care for those who need it and can’t afford it, I bring up the absurd notion of "charity." We are all human beings, and most of us in this line of work have compassion. Personally, I donate a large amount of money to charities every year; charities which I feel do an excellent job. For those of you who think the government is the best charity to handle this endeavor, look at how carefully they handle your money and how efficiently they produce things like new roads and highways. Do you want more "evidence-based" medicine like blood cultures in uncomplicated pneumonia? (hopefully the sarcasm came through in those comments). The free market would do a much better job of caring for sick people than our current socialist system. Wouldn’t it be great PR for a hospital to have an entire charity wing? I think a doctor would acquire many more patients when it became known that he or she spent even one day per month doing free care. Of course, the legal system would have to be drastically revamped in my world, but that is a topic for another time.

When the system you propose requires that you use a word of violence like Tsar, it is time to rethink that system.

Todd Arkava, MD
Nashville, TN