Paul Hochfeld is an emergency room doc in Corvallis, Oregon.

He’s a little bit irritated with the Democrats in Congress.

In particular with Nancy Pelosi.

He has sent Pelosi a letter.

Here it is.

The Honorable Nancy Pelosi
United States House of Representatives
235 Cannon House Office Building
Washington, D.C. 20515-0508

May 2, 2009

Ms. Pelosi,

Despite all the talk of change, most of the noise emanating from inside the Beltway suggests that in health care, we are going to get more of the same:  employer based care, more cost, and more government subsidies so the insurance industry can continue to profit from an inefficient delivery system.

This means that 7-8 years from now we will be in the same mess and our government will be facing insolvency from yet another direction.

In your zeal to fix the problem of Access by giving everybody “insurance” you are ignoring the real problem: Cost.  Only a “single payer”, with both authority and responsibility to control total cost, can do so.

The taxpayer is already footing 60% of the total bill and our insurance premiums are already inflated by 10-15% to cover the cost of the uninsured.

We are all paying for everybody anyway, so why not design a system that reflects this?

Admittedly, crafting a sustainable delivery system that is publicly financed and privately delivered won’t be easy.  It will require fixing Medicare.  It will require re-visiting current reimbursement schedules that result in radiologists, orthopedic doctors, and anesthesiologists earning three times as much income as primary care providers.  It will require telling patients that we can’t use public money to pay for expensive, marginally beneficial interventions.  And more.

Some people will call this rationing, but isn’t it better to ration rationally, on the basis of scientific evidence and social justice, than in the name of profits… as we currently are?  We need leadership to raise the discussion to the level of reality.

The government has a moral responsibility to ensure that we taxpayers are getting the most health and the least suffering for our health care dollars.  You know this.  Your peers know this.

It would appear that the only people that won’t admit it are those in The Industry who are using their lobbyists to put pressure on you to craft legislation that primarily sustains their profits.  Why not listen to the majority of Americans who favor “single payer”?

Please, listen to us and put publicly financed, privately delivered health care (aka single payer) on the table for consideration.   To simply write it off as “politically not feasible” is no longer acceptable.

Our legislators were elected to lead.

I fear that health care reform is less about health care than the political process that is broken for the same reason.  It’s mostly about money.  By your actions, prove to us this isn’t true.

Be well.  Being otherwise is very expensive.

Paul Hochfeld, M.D.
Emergency Physician

p.s.    A video “Health, Money and Fear” that illuminates the multiple causes and perverse incentives that drive up cost is available for viewing, in chapters, at www.ourailinghealthcare.com.  Health care reform must address the elements of the problem or it won’t be the reform we need.