Health care reform: Market forces can do better

In his editorial, “Setting the record straight,” (J Fam Pract. 2010;59:615), Dr. Susman correctly observes that health care reform should cover the uninsured, preexisting conditions, and preventive services, and prohibit denials for the seriously ill. We all agree. He says “ObamaCare” does that, although not perfectly, and labels criticism of the health care package as politics, fiction, and “downright disgusting.”

But why does government need to be the instrument by which we achieve these goals? Market forces can do the same thing by making government a partner—not a prosecutor—by legislating interstate competition by insurers; free access to medical savings accounts; and meaningful tort reform. Obama-Care does little of this, especially tort reform.

Dr. Susman implores us to ignore politics and become patient advocates. (Just get the job done any way possible.) But this is irresponsible and impractical.

Forty years ago when I practiced in Canada, I ignored politics and solely advocated for patients. The vast majority of doctors simply accepted the concept of giant government intrusion—and we got it. We got a plan that covered all of Dr. Susman’s concerns. But we also got hospital closures, severe rationing, long waiting lists, outdated equipment, confiscatory taxes, and looming bankruptcy. We were zealous, but extremely naïve.

Today, Canada is desperately trying to privatize, while the United States is desperately doing the opposite. Why is it that the same doctors who implore us to practice medicine based on evidence refuse to practice evidence-based social engineering? How many failed social experiments must these academics witness before they realize that big government can’t run health care well?

Calvin Ennis, MD, FAAFP
Pascagoula, Miss