I had the occasion today to chat a bit with my friend (and mentor of sorts), a retired orthopedic surgeon, about the state of medical care, and the reforms indicated.

As you might guess, he is no fan of big pharm or of the insurance companies. Nor is he a fan of trial lawyers. ( He told me a story about an attempted lawsuit where he had seen a young girl of age 9 who had taken a spill, radiographs normal and no symptoms, who became a world class gymnast around age 14 or 15. She developed a problem with her back, and her family, encouraged by attorneys, had decided that he should have noted this back when he saw her 6 or so years earlier. Records and radiographs indicated and showed that there were no problems to "see" back then, but this girl was never going to reach the heights as a gymnast that she might have without the back problem, and the family wanted to sue for potential lost income. Could have been a huge number. Fortunately for him an article came out the very next month in the major ortho journal showing that the sort of injury she had was almost never found outside of gymnasts.)

He told me that he is convinced that the only equitable solution to our health care problems in our country is to have a government run single payer system. While he admits that this is a form of socialism, he said that most everything our government does is "socialism" including our military and our education system. Some things NEED to be socialism. Health care is one of them, in his view. He further points out that insurance companies in other industrial societies have done quite well selling policies to cover what the single payer does not.

He also felt that doctors should probably be indemnified against lawsuits to some degree. (This is not to say he thinks bad doctors should be permitted to continue to be bad.) He says that too many doctors are hiding behind tests as "defensive medicine" to cover their own lack of knowledge. The courts love this approach, but it's wasteful.

Then he also said that he believes everyone needs a "boss" but too many doctors don't have one. Outside of the courts, where doctors can lose big, and thus cover themselves with enough tests, indicated or not, there is often no professional recourse. He feels that the biggest punishment would be loss of priveleges at hospitals. Punishment like this would pretty much eliminate them as viable choices for people, he feels. He says that doctors that DO have a boss, like maybe they work for Mayo Clinic, have just this hanging over their heads, and presumably, though I didn't ask him for statistics, there is less malpractice in these sorts of settings.

He also feels that dental care should be part of any national health care plan. I accept this, but I also know what sort of dental benefits the government gives their employees now. Their reimbursement levels are abysmal. They're the same today as they were 25 years ago. If this is the sort of dental reimbursement they include in such a plan, there won't be any dentists able to take it. But that's beside the point here.

It was an interesting discussion with my friend, quite enlightening coming from a medical professional who has clearly put a lot of thought into it.