09/28/2009 05:12 am ET Updated May 25, 2011

What to Ask at a Town Hall on Health Care


Like you, I am concerned that the health care reform proposed will not fix health care. I tried to attend our local town hall meeting on health care but could not get in. I had prepared some questions in advance that I believe speak for all of us (or at least most). I offer them below for you to consider asking at your town hall meeting and in letters or emails to our Representatives.

More (!) Bureaucracy?
The Healthcare Reform Bill will create three new governmental Agencies: The Health Benefits Advisory Committee, The Health Choices Administration, and the National Health Care Workforce Commission. The single largest cost item in all of health care -- expending more money than what is paid to all the providers put together -- is what someone called the "waste of the middle." Won't adding three additional bureaucracies just add even more useless cost to system already over-burdened with administration?

Not fixing "the system"
The President has repeatedly said that the health care system is broken and needs reform. Yet the Reform Bill addresses one part of one aspect of the financing of health care and not the shortages, the errors, the inappropriate profit-taking, and not even one of the eight value-less root causes of skyrocketing costs. How can you say the system is broken and then not fix it -- the system? (Oh, sorry, please do not say that we need to one thing at a time or fix healthcare step by step. The greatest truth that systems thinking has shown is that in the modern world, it is impossible to fix only one part of a system: you have to fix the whole thing.)

Raising (!!) Costs?
President Obama started this health care discussion by saying that the costs of health care will pull us down as a nation. Now we see a Reform Bill that will add over $1 trillion to the deficit. We need to reduce costs as a nation, and the Bill will dramatically increase our costs. What am I missing?

Believing Government Estimates
At its most optimistic, the Reform Bill is projected to be revenue neutral. (I do not understand this as the President said our most critical need was to reduce healthcare costs.) In 1964, the Medicare Bill was crafted to include careful cost projections. In 1990, GAO reported in that MediCare cost over 800% more than the original estimate and now reports that MediCare will go broke by 2016. Why should we believe any rosy Government cost projection when history shows they are always wrong and we end up paying?

Management Malpractice
If a doctor recommends treating the symptoms but not the cause of my illness and if there is no evidence that her suggested therapy will work, is this not medical malpractice? Applying the same logic to the Reform Bill, why isn't Congress guilty of management malpractice?

Does health care come with any personal responsibilities?
Canada and Great Britain - both touted as universal health care systems that we should adopt -- have come to realize that they cannot deliver on-demand care as an unlimited entitlement. Both are trying to inject some personal responsibility into their systems in order to create feedback...and failing. How does the Healthcare Reform Bill avoid that same pitfall: implying it can deliver unlimited care without bankrupting the nation?

Is there a quick fix?
The President raised the continuous crisis of health care to national prominence. Great! Why should anyone believe that a quick fix is possible for a problem that has been growing for more than fifty years?