I think Sherry is right – if we’re looking for a simple solution, it would be single-payer. I don’t think we as a nation are ready for single-payer, though, so a compromise with the elements listed above is the course we should follow.

Good discussion here. I wish we could have had this type of rational discussion from the get-go on health care, but … better late than never!

Thanks, David, for letting us share your column with our readers. This is the kind of give-and-take that needs to be going on.

Most of this doctor’s complaint is about contracts that he voluntarily signed with insurance companies. He says:

Physicians are not permitted to negotiate their rates with patients that don’t have health insurance. The contracts that physicians have to sign with private insurance companies forbid it, and federal law says that it is fraud for physicians to do so for Medicare copays.

First, David, nobody held a gun to your head and made you sign that contract with an insurance company. If you have a problem with the contract, refuse to sign it. Lots of doctors have made precisely that choice. It sounds like you want to be in a PPO network (which guarantees patients low rates), but you still want to jack up the rates and charge whatever you want!

As to Medicare, it is true that if you choose to treat medicare patients, you have to accept medicare rates. Once again, you want the benefit of a large pool of potential customers, but you want to charge whatever you want. To be clear – you are already free to “negotiate” lower copays with Medicare patients. What you want to do is “negotiate” higher copays. How will it help bring down health care costs for you to be allowed to charge higher amounts.

Other than allowing you to charge higher rates, your only suggestion is health care savings accounts … which we have had since 2003, and have not helped at all.

So your “real health care reform” consists of 1) charging patients more; and 2) health care savings accounts that we already have. No suggestion for how to lower costs or reduce the massive number of uninsured.