First Edition: August 21, 2009

Theme : The public health is a fundamental human right.

1.  When the public health is also one of commodity like a house, we come to a tragic and unthinkable conclusion :  As to for-profit business, the more ill patients get, the more profits they make.  

Under the most wasteful structure on the planet like no coordinated preventive care program waiting until people get ill, a pay for each and every service reimbursement and frequent readmissions, no e-medical record and deaths, crushing litigations and the more profits via the unnecessary procedures, and the most inefficient paper billing systems imaginable, overpriced pharmaceuticals, bloated insurance companies, medial fraud, exorbitant costs by the tragic ER visits etc, it might be no wonder with the expansive, systematic reform in the pipeline, just one attitude of patient-oriented value in 10 regions has attained 16% of savings in Medicare while their quality scores are well above average.

Aside from the already allocated $583 billion and the savings of this reform package, 16% of $923.5bn (the combined Medicare and Medicaid cost per year, as of July) is around  $147.76bn per year and 1.4776trillion over the next decade, and this patient-oriented value alone could be enough to meet the goal.  

Please be 'sure' to visit www.nytimes.com/.../13gawande.html?hp  for credible evidences !

Today, another innovative, fundamental change in payment system, or patient's outcome based payment reform that is able to turn the profit-oriented malpractices and volume into the patient-oriented value and quality is waiting for a final decision.

2.  The savings via removing wastes turn into limit to medical access, rationing, tax raise, and deficit etc via the irresponsible lies.

Unlike high fuel price and mortgage rate in recent years as the roots of great recession and bankruptcy of middle class,  the severity in the high cost of health premiums has come to light lately. Similarly, in an attempt to hide these painful corruptions & wastes, the greed allies struggle to turn the savings via removing these wastes into limit to medical access, rationing, tax raise, and deficit etc.

In contrast, not to mention a wide range of consumer protection, this promising reform takes initiatives in more primary care docs and improved long-term care. Unnecessarily, hope should not be replaced with fear, just like people don't have to fear quitting drug.


3.  Under the free market theory and the premise that the public health is also one of commodity like a house, if the demand decreases on a large scale, accordingly the price tends to reflect it, as in the case of house price, and it never happens for the price to spiral up. One step forward, in case the price is spiraling up, to be sure, the remaining clients should withdraw the contract or choose the other options.  Sadly, no way-out other than the prohibitive ER is allowed in America. Therefore, the victims today and tomorrow deserve long overdue protection from non-profit Government.

4.  When some part of our body is ailing seriously, we are going to lose competitiveness, equally, when some part of a nation is ailing servery, it is going to loose competitiveness, too.

5. Unlike the original financial concern over recovery from Catrina catastrophe, the recovery work is going smooth with no big problem, to my knowledge. The last thing to want would be for this health Catrina to be left untreated. And there is enough room for savings from the unsustainable wastes.

6.  Equation (By decade)  &  the flower of this reform !

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (so-called doughnut hole) + $155bn (savings from hospitals) + $167bn (ending the unnecessary subsidies for insurers) + 129bn(mandate-related fine)  + $277bn (ending medical fraud, a minimum of 3% , the combined Medicare and Medicaid cost of $923.5bn per year, as of July,) = $1.391trillion + the reduced cost of  ER visits (Medicare covers some 40% of the total) + the tax code on the wealthiest  more reduced than originally proposed = why not ? (except for a magic pill, an outcome-based payment reform & IT effects and so forth).

Additionally, the last thing to expect, no e-medial record(under a fee for each and every service payment, hospitals are resistant to introduce IT system) , is happening now in the sector requiring the best accuracy in terms of dealing with human lives, which leads to a shocking portion of risk-carrying duplicate tests, fatal errors and deaths, as a consequence, these cause a vicious circle, about $100bn worth of litigations and even more profits via unnecessary procedures for hospitals .

Clearly, the American style innovation, outcome-based payment reform, could speed up the adoption of IT system, under this package, docs' pay is dependant upon patient's outcome, no intervention, wastes, frequent readmissions, low-quality are allowed later on.

It is firmly believed with the preventive care program in operation, this innovation could make a big difference just like GM has surprised the world with the adoption of EV-conversion technology from pioneers and outpaced the excellent hybrid cars (the release of BYD's earlier appearance in America and the ambitious plan of Germany for 1million of EVs by 2020 etc  might support it).


7. Over the duration of time-consuming discussion surrounding this common sense, a fundamental human right, and slow down to shout and disrupt, and lie irresponsibly, America has been loosing market share in a futuristic sustainable energy arena. But just like if a country attempts to steal cash from wall street, America can't wait and see, so the opposite is the same. Taking the invaluable lives and gigantic war spending into account, it can be cited as one more extended reckless disaster, regardless of the result, as this great recession says.

Please note that time does not fix the endless greed, energy depletion, only science and innovation can meet the challenge.

Thank You !