A Doctor – Economist’s Solution for Health Reform

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Slow down!


Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!


There you have it; direct and straight forward. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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6 Responses

  1. Bravo, Dr. Marcinko. Keep pushing.
    D. Kellus Pruitt; DDS


  2. Dr. Marcinko,

    Your diatribe was excellent and I agree with it to a large degree. But, it gives precious little detail; just like the Obama Administration.

    Still, at a single page, it was an easy read that killed no trees. No doubt it was also much more cost-effective to produce than the thousands of written pages that few legislators or political pundits actually review. And, I think the push-back fervor against Obama will only increase:


    There will be no healthcare reform, as the current Administration postulates. Many thanks for your concise brevity.

    Dr. Jack


  3. Dr. Marcinko,

    So now the California HealthCare Foundation (CHCF) would like to scrap FFS medical reimbursement? You are a visionary.


    Dr. Gulbert


  4. Obama’s Healthcare Plan
    From: Pat Caputo, DPM

    Do not confuse the Medicare Program with paying $13,000/year in premiums for real insurance for a family plan. Medicare is not a real insurance plan, and only works because it is a giant pyramid or Ponzi scheme. The SEC has a website devoted to “pyramid” and “Ponzi schemes” {sec.gov/answers/pyramid.htm } {sec.gov/answers/ponzi.htm}.

    Quoting the SEC website, “The Ponzi scheme continues to work on the “rob-Peter-to-pay-Paul” principle, as money from new investors (working people paying taxes) is used to pay off earlier investors (retired people) until the whole scheme collapses” (My additions parenthetical).

    I try to tell my Medicare patients that the money that they paid into the system is essentially gone, and was used to pay their parents’ Medicare expenses. The money that is used to fund their care today is from today’s working people. We are robbing Peter (the workers) to pay Paul (the retirees).

    If we enlarge the Medicare system beyond the retired people, this pyramid will undoubtedly collapse, and very possibly with it, our entire economy. If WE THE PEOPLE cannot afford healthcare, do not think that WE THE GOVERNMENT can!

    Source: PMNews – September 21, 2009 #3,654


  5. Dr. Marcinko,

    Excellent post. Here is a link for more info on P4P – episodes of care – and global insurance coverage, etc. Enjoy.




  6. Economics Arguments for a Public Health Option




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