To Secretary-designate Daschle

The Obama transition team, in its brilliantly technological effort to make all Americans with a computer feel involved, created the change.gov website. So, I was wandering the site, and discovered that I can write to the transition team for health care, and share my thoughts with them. I can also post them on the site for all to see and argue with, but I wasn't ready for that yet.

Here are my thoughts as of today. Help me refine them, or send Daschle your own email.

What we have today in the US cannot be called a health care system. It is not integrated, does not have stated goals, and does not serve the lifetime health needs of our citizens.

We badly need health care reform in the US, but it will have to be implemented incrementally, and with popular support. This support should be measured not in the number of dollars a particular industry or professional organization is able to muster, but in the number of citizens, academics and health professionals in favor of the measures.

In order to build a health system that allows everyone access to the human right of health, reform must address many sectors.
1. Health Education
2. Pharmaceuticals
3. Medical Malpractice Laws
4. Distribution of physicians and health services
5. Financial incentives for health professionals

1. HEALTH EDUCATION
The education of our doctors needs to be adjusted in two ways. First, preventive health and primary health care should be highly emphasized in the medical curriculum. Second, young doctors should not be burdened with so much debt that they are no longer able to consider going into primary health care and must consider specialty training.

Furthermore, health education should be promoted by the government through the use of public service announcements, rather than motivated by the producers of certain products or procedures. The food stamp program should be adjusted to make the purchase of fruits, vegetables and juices more attractive than various forms of corn syrup (soda, chips, cookies, etc.) Health needs to be recognized as not just the domain of the DHHS, but intertwined with agricultural policies and welfare polices.

2. PHARMACEUTICALS
It is clear that one of the major costs of health care today resides in drug prices, and drug prices in the US are higher than anywhere else in the world. Americans should no longer have to shoulder the unfair burden of subsidizing R&D expenses, nor should we be bombarded with advertisements for prescription medicines. The government should seriously consider creating a national list of essential drugs, and mandating that all of those drugs be available in their generic formulation.

3. MEDICAL MALPRACTICE LAWS
A cap needs to be placed on medical malpractice payouts, so that the insurance costs for physicians does not prevent motivated doctors from taking up certain specialties. Legal oddities such as the fact that the obstetrician can be sued for a child's disabilities until the time that child is 18 years old need to be revised. If physicians are better protected by the law, they will not feel obliged to order a myriad of tests in order to prevent their diagnoses from being questioned by lawyers, keeping medical costs down and morale up.

4. DISTRIBUTION OF PHYSICIANS AND HEALTH SERVICES
While physicians all over the world flock to urban centers, provisions need to be made to make health care, particularly high quality primary health care, available in an equitable fashion nationwide. Perhaps doctors need to render service to under-served communities as part of their medical training. Perhaps physicians receiving certain federal assistance repay their "debt" by practicing in less desirable locations. Once all Americans have access to health insurance, physicians serving in rural, poor, or remote communities will be assured of payment for services rendered.

5. FINANCIAL INCENTIVES FOR HEALTH PROFESSIONALS
Whether it is the medicare payment scheme, or incentives given by insurance companies, physicians and hospitals in this country are financially incentivized to do more procedures, more tests, and even change diagnoses to those which pay more. What if doctors were paid to keep people healthy rather than make them healthy? What if illness were seen as a failure of the medical establishment to have done something sooner, rather than as an opportunity to rake in money? Obviously, this does not apply to all illnesses, but considering the number of chronic conditions which are preventable, having the primary function of the health system be health rather than healing is not revolutionary.

Suppose the motivations of the health system became realigned so that primary care physicians prevented heart disease by counseling over-weight individuals, or so that a great deal of kidney failure was prevented because a primary care doctor ensured that a poorly educated patient was able to monitor and control his insulin levels. Unemployed cardiologists and un-used dialysis machines could then be viewed as a sign of success.

Think about it.

And while you are thinking, do not forget to make use of those experts who are not funded by special interest groups.