Sidney Goldfarb,

Urological Surgeon

A lot of attention will be placed on reforming our current out of balance health system. As a practicing physician who ran for Congress in 1994, I believe that no one seems to propose what a physician would. I am a urological surgeon, so I like to fix things with the sharp edge of a scalpel.

We do need to replace our current health insurance system and managed care disaster with a non profit PRIVATE SECTOR company to transfer payments between patients and doctors. This could be considered a utility company, mutual company owned by the enrollees, or a co-op. The current insurance companies operate with a profit margin of 14 percent and other overhead expenses that total 20 to 40 percent of total premium dollars spent. Why only consider a takeover by the broke Federal government?

No one considers the doctor’s expenses of billing and appealing denied claims. This could be one or two employees per doctor. A new system would get rid of the adversarial billing that we and patients currently experience. A new system should have the patient owning the policy, not the employer. The employer still could subsidize the costs of valued employees as is done currently. This would make the insurance transportable for life and obviate pre-existing conditions. We could then emphasize prevention which eventually would save more money.

Malpractice and the fear of a lawsuit on the part of doctors leads them to practice defensively. This cost can only be estimated, but approaches 20 to 25 percent. Most defensive medicine consists of expensive technology, such as MRI and CAT scans. A better system would be mandatory arbitration of all encounters with patients. Other possible new systems are workers compensation-like or health courts where the experts are hired by the court.

Doing both health care insurance and malpractice reform would save 40 to 50 percent of total private sector costs. Doctors could get paid more, patients and businesses would pay much less.

What would federal based health care be like? Further cuts to Medicare fees will cause more doctors to drop out of Medicare participation. Already psychiatrists, internists, orthopedists, neurosurgeons, and gynecologists are dropping out of Medicare. Who will take care of our increasing elderly population?

Also, all of the federal trust funds have zero in them. This was battled over in 2005 in the privatization of Social Security debate. The General Accounting Office website shows that every dollar in a trust fund, Medicare, Social Security, Federal employee retirement plans, etc., is offset by the liability of the Treasury to pay the bill when due. A socialized system would force the government to ration care to save itself money it doesn’t have.

Doing these things would lower costs by up to 50 percent and bring the U.S. in line with England or Canada in terms of percent of GDP spent on healthcare, and we could keep our current better brand of medicine. We could insure two-thirds of our uninsured because the insurance would be cheaper. Studies by the Heritage Foundation show how we could insure people under 30 and the people who already qualify for Medicaid but don’t apply for very little money. Also people who make over $75,000 a year could get a policy if it were more affordable. The people left, about 15 million, are primarily illegal. We also, in the U.S., take care of visitors to the U.S. for free. Can we still afford this?

We need consumer-driven health care as described in Regina Herzlinger’s book, “Who Killed Health Care.”

If we can save our system of providing the best care in the world and save 40 to 50 percent, the question is: why not do it? I hope President Obama and Senators Dashle and Max Baucus can read this.

Sidney Goldfarb MD, FACS is a urologist in private practice at 419 North Harrison Street, Princeton. 609-921-3008.

Betsy Ryan, President,

NJ Hospital Assoication

Someone recently asked me what my greatest hope for the Obama Administration is, and what my greatest fear might be. My greatest hope (from where I sit) is easy — that once he is sworn in, President Obama will tackle healthcare reform and provide healthcare coverage to the 43 million-plus Americans who do not have healthcare coverage.

My greatest fear is that his administration will be so consumed with our nation’s economic woes that he won’t get to healthcare reform. But the irony is that tackling healthcare reform is essential to our nation’s economic recovery. Healthcare is 15 percent of the gross domestic product nationally. Hospitals are often the largest employer in the communities in which they serve. In New Jersey healthcare is the state’s second largest source of jobs, with hospitals alone employing close to 150,000 New Jerseyans in full-time and part-time positions. All told, New Jersey hospitals are economic engines that pump billions of dollars in salaries, income taxes and purchased goods and services into the state’s economy.

But beyond the dollars and cents, hospitals serve as the safety net for all of those who lack health insurance. State law mandates that hospitals provide care (we call it charity care) to those who don’t have health insurance and can’t afford to pay. As the unemployment figures continue to rise in our state, that hospital safety net becomes even more essential.

So. hospitals provide jobs and add billions of dollars to the state economy, all while providing a vital service to all our residents. That, to me, makes hospitals an essential component of any economic recovery.

Betsy Ryan is president of the New Jersey Hospital Association (NJHA).

Barry Rabner, CEO,

Princeton Hospital

I hope that President Obama will make healthcare reform one of his top priorities. The United States has the highest healthcare costs in the world. We are also the only major democracy in which a huge percentage of the population has no medical insurance. Continuously rising health costs put American businesses at a disadvantage in the world market, while our health system overall ranks just below Costa Rica, but just above Slovenia and Cuba.

Fundamental reform is necessary because the problem is great and the causes many. Incremental change will have little useful impact. The interests of key participants in our nation’s healthcare system — patients, doctors, hospitals, insurance companies, employers — are unaligned and a shared purpose is essential.

Barry Rabner is CEO of the University Medical Center at Princeton.

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