August 03, 2009

‘Eliminate private health insurance’ says former NEJM editor, 10 July, 2009, Kathlyn Stone SOURCE: Flesh and Stone

A senior physician-academician and former editor of the New England Journal of Medicine says none of the leading health care reform proposals being considered by Congress address the underlying cause of the health care crisis: out-of-control costs.

Dr. Arnold Rehlman, author of A Second Opinion: Rescuing America's Health Care, has outlined the problem and offered solutions from his catbird seat as physician, Harvard medical school professor and journal editor. Rehlman was a guest on NPR’s July 10 Science Friday program. He said none of the leading proposals for health care reform, including President Obama’s “public option” plan, address the underlying problem of spiraling costs due to a system devoted to profits.

He said if the Obama plan passes “we’ll spend billions and billions more covering people that are currently underinsured,” adding that extending health care is a good thing. “But it will break the bank.”

Rehlman’s recommendations for fixing the health care system are to:

* Eliminate incentives for overpricing and under providing of care.
* Make the entire health care system non-profit.
* Eliminate insurance companies, the “middlemen” of health care.
* Have physicians and other clinical staff work in multi-specialty health centers and be paid a salary by a single-payer government entity.


He also spells out how to pay for a reformed health care system. Eliminating private, for-profit insurance would reduce health care costs by 40 percent. Eliminating unnecessary tests and treatments would reduce costs by about 33 percent. Bundling those savings along with the 10 to 15 percent allowed as tax deductions for employers providing health care to workers and placing them into a central non-profit system would achieve health care for all, he said.

Rehlman diverges from other single-payer advocates that are calling for a “Medicare for all” type program. He says Medicare isn’t a perfect model because it doesn’t control costs either and “its costs are rising almost as fast as for-profit health care.”

While he continues to speak out in the media and to medical associations, Rehlman is pessimistic that the U.S. will achieve health care reform because industry will not readily give up the billions made by private insurance and pharmaceutical companies, and hospitals, both private and non-profit, that compete for patients in the current system. Further, the health care industry “controls the legislature by virtue of all the lobbying,” said Rehlman.

Rehlman started talking about the non-sustainability of the U.S. health care system 25 years ago. His ideas are getting a wider audience today as politicians respond to public demand for health care reform.

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