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On a seven-mile hike up Flat Top mountain in North Carolina with my nephew, a young family physician, he shared what his experience is like in an emergency room practice in a medium-sized southern town.
He and his partners staff the hospital and serve a patient population that is one-third insured, one-third on Medicare and one-third uninsured. With the few exceptions of those who can afford to pay at least something before pleading bankruptcy, the cost of treatment for the uninsured has to be built into what is charged for the insured people. This is what everyone has been saying all along, but my nephew just confirmed that it wasn't some urban myth.

So, if we manage to insure all those uninsured people through some form of payroll tax or mandatory coverage, then the cost should remain the same. We're already paying for them with costs that are built into the existing premium structure. We can be assured that somebody is paying for the uninsured, or my nephew, with three small children, would not be working as a doctor.

The government will have to adopt a payment format (taxes or mandatory premiums) to cover the currently uninsured, and the rest of us should see our health insurance premiums drop as our taxes go up to cover the cost of the program - like taking a bucket of water from the shallow end of the pool and pouring it into the deep end. Ultimately, it becomes a "wash" transaction but with the advantage that everyone, technically, can say they are insured. Uninsured or partially-insured health problems will no longer be the nation's No. 1 cause of personal bankruptcy.

Reducing costs overall should easily start with the cost of drugs. There are three drug industry lobbyists for every congressman today, and the industry spent $100 million to successfully ban the right of Medicare to negotiate for the price of drugs they provide.

I wish it were legal to point out to the drug industry that, for example, those eye drops that cost $15 per bottle amount to nothing more than 99 percent water and 1 percent diluted Vaseline. According to a retired patent attorney who knows these things, the cost of the eye drop product is approximately.001 percent of its retail cost. Doing the math illustrates that the cost of what's actually in the bottle has been marked up by 1.5 million times its cost.

Overall, the ability to negotiate drug prices in behalf of the nation's Medicare patients would have a huge impact on cost reductions. Those $15 eye drops might reasonably cost just $1.50 for packaging and shelf space. All over the world, starting with Canada, negotiating prices is the norm, but the toxic mix of campaign finance practices and career politicians makes it impossible in the United States.

Why on earth do we now allow full page ads aimed at consumers that promote prescription drugs? It used to be illegal to advertise anything beyond over-the-counter medicine. Now, all these ads are creating a nation of obnoxious hypochondriacs (the "worried well") who are equipped to start telling their doctors what they think they need. With the cost of advertising built into the price of drugs, some of us, for example, are actually paying to be continually reminded that Levitra, Cialis and Viagra can improve quality control? It's just nuts.

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