Weighing in on the health-care debate

Weighing in on the health-care debate


As a physician, I eagerly read “Taking the pulse of the Jewish community in the national health-care debate” (cover story, Aug. 14). Health-care reform is urgently needed, and I heartily support the organized Jewish community’s focus on this moral issue.

Most particularly, I applaud Jacob Toporek and the N.J. State Association of Jewish Federations with its compassionate support of viable and important long-term care options as outlined in the CLASS Act (offering frail adults cash benefits to pay for common daily activities such as dressing, bathing and eating, enabling them to live with dignity longer within their community and at home).

However, I was hoping for a more balanced approach in the health-care debate. How can one measure the pulse of the Jewish community regarding health-care reform without consulting Jewish physicians, Jewish nurses, Jewish hospital CEOs, and Jewish members of pharmaceutical companies? Is it a rational approach to a health-care debate to just take the pulse of politicians, rabbis, and the organized Jewish communal world? By excluding physicians, you are missing 20 percent of health-care expenses; also, hospitals represent 40 percent and pharmaceuticals 10 percent of the health-care pie.

I certainly would like to see universal health-care insurance instituted and equitable insurance rates given to those with pre-existing illnesses. Nevertheless, I was struck by several possibly misleading misstatements. Barbara Weinstein of the Reform Movement’s Religious Action Center says, “It is no longer acceptable to have 90 million Americans without health insurance.” The Congressional Budget Office, the official arbiter of the costs of any federal budget legislation, states the number of uninsured is 37 million. Second, in the article, it is noted favorably by the budget office that the CLASS Act will reduce health care costs by $59 billion, but never is the actual $1 trillion price tag noted, even after all the revenue generated by new taxes on employers, small businesses, and individuals earning over $280,000. In addition, another $500 billion will be necessary for Medicaid and other federal expenses.

The statement by Rabbi Eric Yoffie of the Union for Reform Judaism that “we live in a country with a pitifully inadequate health insurance system that causes horrors every day so tragic that they could rip the heart out of a stone” is too harsh. We live with a health-care system that has to deal with the highest teenage pregnancy rate in the industrialized world, the highest incidence of obesity in the world, and a society that continues to see an increase in the astronomical numbers of prison incarceration for drug and gun use.

We need to get to the core of the inflated cost of our health care system – I refer to the use of futile care at the end of life, estimated to be 25 percent of the total yearly cost of Medicare. This is especially apparent in patients who have chronic illnesses and have already signed living wills. Also, the need to practice defensive medicine to avoid malpractice suits significantly adds to the costs of our health-care system and needs to be addressed in the current health-care proposals.

We must pursue transparent, portable, price-competitive, and equitable for pre-exisiting illnesses health-insurance policies that would reward physicians with higher payments for providing preventive care and would offer patients lower premiums for doing the same. Tax benefits should exist for the uninsured and self-insured, as they exist for employer-sponsored insurance. Insurance must be structured so that consumers have a monetary incentive to learn prices and seek value.

These concepts are critical and should be more highly refined in the health-care debate. I believe in universal health care coverage, but instilling individual responsibility for one’s own well-being starting at a young age is essential.