Soliliquy #4

Since I started talking about decreasing health care costs, here are some more ideas.

I don't understand why MediCare and MediCal programs are so expensive and inefficient. Well, I do know why, at least partially.

Part of the problem is that they are government-run programs, and let's face it, people get government jobs for pensions and security. Perhaps this will make me hugely unpopular with my colleagues of yore, but I really think that if physicians who work for the government actually worked, they won't need so many physicians. The problem is that the physicians are salaried, and when people are salaried, in a secure position, with pensions, they are just not motivated to do work. If those doctors actually got paid for the work they do, I would say, they really only need 1/2 to 2/3 of the staff. Seriously.

For instance, when I worked at my old job, we fought tooth and nail to not see more than one new patient a week. These days, I regularly meet 2-3 patients a day. Yup, your tax dollars, hard at work.

Fortunately, or unfortunately, people are more motivated when given the right incentives.

I think, we should do away with county health services. Instead, there should be a loan forgiveness program for people who work exclusively with MediCare and MediCal patients. There are currently programs like that for serving Native Americans on preservations, or with the military. Why not expand it? I would have gladly worked in such a place if my education loans could be forgiven, even partially!

It would also help tremendously if we do away with existing pension programs. I know, it is not a popular thought, but the truth is, we can't fund them anyway, and to go on pretending is really foolish.

I think people should have options, to go into Social Security or to private programs, such as 401(k)s. For those people who just don't want to think about investing, they can opt to go into Social Security, while taking the biggest risk of "It belongs to the government and let's face it, the government is broke." Or, "Let me take this seriously, that the market can fluctuate, and I need to be responsible."

President Obama made a speech about how social security shouldn't be privatized and that Social Security, as a government program, is much safer and people need that kind of safety. I think he made the speech about 2 weeks ago- I saw it while walking on the treadmill on my cruise trip. I mean, does he really think Social Security is secure?!

I have a patient, who retired as a school teacher and saved responsibly during his career. As he neared retirement, he followed the rules and pulled out his money from stocks and bonds, and bought CDs instead. He did this in 2006, when the market was still going up and up. He locked in rates of 6% on CDs! So he is laughing on the golf course while his closest friends, who are still working as physicians slave away fighting for reimbursements.

I do think people should be made to save, just like money is sucked out from each pay check for social security, we should be able to choose where that money goes but no choice in the fact that money has to be saved somewhere.

Perhaps we can learn from China, where entitlement programs don't exist, and people save at a rate of about 40%. Is it surprising that they hold most of our debt?