Still think we don't need legal reform? See http://www.MDWhistleblower.blogspot.com under Legal Qualtiy.

Thank you Mr. Huhn

Your second point is perceptive. If the choice is between the Pelosi Bill (or something similar) and no legislation, then I would prefer the latter. Since, given the present make-up of Congress, that covers the universe of actual alternatives, any legislation passed by this Congress will not be, to use your term, "true reform".

To those who would ignore its precepts, Economics is a dismal science. Its very simple. If you want more of some economic good or service then you reward its production. The Obamanistas want to expand coverage of health care. Yet Pelosi's bill reduces the incentives for people to choose medicine as a career. To expand demand and reduce supply is futile policy.

AND: "Becoming a physician entails large front-end investment costs in time and money."
No disagreement on that point. But let's look at it another way. How much less does it 'cost' to become a nurse practitioner or physician assistant? Do I really need to see a 'doctor' at the emergency room every time I skin my knee or have the same bad cold that everybody else at school has?

AND: "Limiting the return will lead many of the most able and gifted to choose different career paths."
What are they going to do instead….become lawyers? (Sorry, I couldn't help myself there!)

AND: "It follows that there will be a decline in both the number and the quality of doctors."
Not true. It could result in a few defectors from eldercare practices completely subsidized by Medicare. However, with a large number of boomers hitting 65 in the next few years, there shouldn't be a shortage of medical students preparing to care for us.

If the "biggest losers" in the Pelosi Bill are physicians, then the quality of medical service will necessarily decline. Becoming a physician entails large front-end investment costs in time and money. Limiting the return will lead many of the most able and gifted to choose different career paths. It follows that there will be a decline in both the number and the quality of doctors.

At the same time the Pelosi Bill (indeed all proposed legislation) will expand coverage. Increasing demand and restricting supply will lead to rationing, or at a minimum, shortages and delays (which are disguised forms of rationing).

As you acknowledge, Congress can address this problem by enacting separate legislation so that medicare reimbursements to physicians are not cut by twenty percent. But then the purported savings disappear.

Thus, it should not be surprising that there is such strong opposition to the various versions of Obamacare now winding their way through Congress. The American People understand that there is no free lunch. Expanding coverage will lead to higher costs or rationing. Or both.

RE: "Health insurance should operate the same. It should insure against catasrophic losses, not routine dental checkups."

What we need is a two-level system of neighborhood preventative/maintenance healthcare programs that are prerequisites for coverages for non-routine losses that would be covered by true insurance policies. If you don't inspect the brakes and change the oil at prescribed intervals, your extended policy won't cover your blown engine or caliper replacements. Allow employers to offer access to hmo(?)-styled programs while requiring everyone purchase a blanket plan for catastrophic health events. That sticky 'pre-existing condition' situation may have to be limited to genetic disorders being covered by some sort of government option. Right or wrong, all other conditions may have to be considered 'preventable' and covered by the same rules as smoking and skydiving for risk management premiums.

Let me answer your challenging question in the affirmative. Yes we can. We can create incentives to promote long-term health care in a system of private insurance. It is already done in the life-insurance market. (Smokers and sky-divers pay higher premiums.)

But this would require treating health insurance as insurance and not as a cost-shifting mechanism. It would also require severing the tie between health "insurance" and employment.

As i have previously stated, the problem is that health insurance has come to be seen as an entitlement. This manifests inteslf in many ways.

First, health insurance is tied to employment. Although there may historical reasons that health insurance is viewed as a benefit to employment (which are reinforced by our present tax code), there are no logical reasons why this should be so. Automobile and homeowners insurance are not typically provided by employers. Reform that would allow the tax benefits of employer sponsored health insurance to be enjoyed by indviduals would be a large step in addressing this anomoly.

This points to a second and more fundamental problem. Health insurance is not really insurance as that term is understood in other contexts. Rather it is, in many respects, an elaborate (and unnecessary) system to shift costs to other parties. When my car requires an oil change or a brake job, I do not consult my auto policy to see whether my mechanic is "in network". When my home needs a new coat of paint, I do not struggle with my homeowners policy to determine my "copay". Yet for the most routine medical expenditures, we have created an army of clerks and accountants to process payments and forms. This is ludicrous. I obtain automobile insurance to guard against large losses, not to cover routine maintence. Health insurance should operate the same. It should insure against catasrophic losses, not routine dental checkups.

This change alone would result in great savings as it would do away with the cost of processing insurance claims for routine costs (as opposed to creating a new federal bureaucracy, which can only add to costs). It would also nullify the debate on whether any reform bill should cover elective abortion The answer is "no" because it would not cover any elective procedures. I don't have to pay for your abortion and you don't have to pay for my face-lift.

Third, we need less government involvement, not more, in the actual detail of policy language and mandated coverages. Such involvement simply feeds tha idea of entitlement. Beyond clearing the field for competion and providing the same tax advantages discused above, the government should get out of the way.

Government can help by allowing insurance companies to sell across state lines. This will increase competition (which will drive down costs for the Professor) and increase choice. Aren't we all pro-choice on this issue?

In short, if individuals owned their health insurance policies, and health insurance operated more like insurance rather a perk of employment, then you would be able to establish long term relationships between providers, patients and insurers. You would also create the incentives to focus on the long term rather than the immediate.