Utah Citizens’ Counsel
Dedicated to improving public policy
Contact – David Carrier, phone – (801) 608-4898, email – carrier.dave@gmail.com
March 15, 2010
Jim Matheson
U.S. House of Representative
240 East Morris Avenue #235
South Salt Lake, UT 84115

Dear Congressman Matheson,
Medical science is now able to provide more medical care, life saving,
healing, and corrective care, than all but the wealthy can afford at one
time or the indigent ever.
Fred Friendly, ten to fifteen years ago, produced a prescient TV series on
the topic with the title, “How Can We Manage Our (medical) Miracles”.
We have yet to find the courage to do so.
We can afford our miracles only if they are paid for over a lifetime and
paid by a collective of everyone. That means cradle to grave insurance
coverage, paid for by parents at first, then the individual adult. It also
means that everyone must pay into the fund, which in sum is everyone’s
“insurance policy”.
How such premiums are paid is open to a variety of schemes, with
subsidy for those unable to pay all or part of the premium. Payment into
a fund over a lifetime will allow all to benefit from the “miracles” that our
medical/science system can provide.
Will the cost be too great? We already pay for the care of the uninsured
with a wasteful system that resorts to emergency care too late and too
expensively and inadequately. We are not prepared as a society, nor
should we be, to let the indigent or uninsured die unattended. We are
generous in the specific case, but we seem to be uncaring in the
Who now pays? All non-indigent taxpayers. As it stands, our insured and
wealthy receive good care. There is no reason for them to lose such
care. But when the total population is considered, the US ranks well
below developed countries in any index of “healthiness”, be it maternal,
adult, or elderly care. Yet we spend a great deal more per capita, two to
three times more, as a percent of GNP, on our total health care costs.
Such an expense imposes an unacceptable burden on our global
competitiveness when the cost of health care is another expense of
production of a car, an airplane, or anything else we need to sell abroad
to balance the cost of imports. The cost of steel in a car is less than the
cost of the health care of the American workers who produce the car.

At bedrock, there are other conditions which are unacceptable in a nation
as rich as ours: 1. Insurance unavailable and/or hugely expensive for
those who do not have coverage on the job. Job paralysis occurs when a
person dare not leave one job for another if coverage is not guaranteed.
2. Denial of coverage for pre-existing disease. 3. Cancellation of
coverage when limits are reached. 4. Cancellation by insurance company
sleuths who receive bonuses when they can find an unrelated paper
oversight on the part of the enrollee, often decades earlier, to provide an
opportunity to cancel coverage when an expensive care bill comes to the
insurance company. Such practices have been confirmed in open
testimony from former insurance employees who could no longer live with
their conscience. 5. In sum, bankruptcy and even homelessness are a not
an uncommon outcome of an uninsured severe health problem.
Still, how can we pay for our “miracles” without draining society of the
other important expenditures, such as social security, education,
There are large savings ready to be developed that have to do with our
current pattern of care delivery. Medicare expenses vary between
adjacent counties without reason except for un-managed waste.
Procedures and studies are too often ordered without good evidence of
value, at the cost as well as risk to the patient. Correction of such waste
can be achieved without “government coercion” by the techniques that
have been developed right here in Utah among other places, Dr. Brent
James of IHC and UU is a leading example. Physicians can be asked to
review their practice patterns in the light of proven “better practice”, and
when so discovered, compliance is surprisingly effective.
Excesses in malpractice awards are often mentioned, and reform could
provide some important savings without denying a victim appropriate
The “new science” of determining how to compensate health care
organizations for “best care” rather than for the number of procedures
performed is showing promise.
Finally, improvement in care and expense can be provided with a renewed
focus on the “general physician” (internist or family doctor) who is in the
position to practice preventive as well as treatment medicine and group
care using providers (physician assistants, nurses practitioners as well as
regular nurses), and others, each providing a variety of skill levels at a
saving of physician time, improvement of physician access for acute
matters, and monitoring of disease, acute and chronic, by such assistants
at lower cost and with the advantage of closer patient attention.

Robert Archuleta
Genevieve Atwood
Aileen Clyde
Gale Dick
Irene Fisher
David R. Irvine
Boyer Jarvis
Chase Peterson
Grethe Peterson
J. Bonner Richie
Dee Rowland
Karl N. Snow Jr.
Emma Lou Thayne
Raymond Uno
Olene Smith Walker
Utah Citizens’ Counsel
Dedicated to improving public policy
Contact – David Carrier, phone – (801) 608-4898, email – carrier.dave@gmail.com