by DAVID E. BROWN & r & & r & GUEST EDITORIAL Neither Michael Moore nor Ron Wyden have it right when it comes to health care reform & r & & r & & lt;span class= "dropcap " & I & lt;/span & was eager to read your cover story, "Is Michael Moore right about health care?" (8/9/07) to see if anyone has truly identified the real issues with health care. I am still disappointed. I know why: You have people who don't work in the health care field trying to identify why we are in crisis! I applaud everyone's efforts in wanting to help, but first we have to agree on what the problems are to fix them, and the problems are multifaceted.

Each of us has some responsibility for this problem, which is exactly what Sen. Ron Wyden stated. We have sick care and not health care, due to the fact that our nation, as a whole, is unhealthy. We are overweight, eat wrong, deal poorly with stress and seek health care when we are in a crisis mode. We have segments of our society that are addicted to prescription drugs, and we are not dealing with them in an appropriate manner. We support their use by continuing to prescribe pain medications to non-acute complaints of pain to people who go to many ERs with various inconsistent pain complaints. The easiest way to treat them is to give them what they are seeking, so as to not have to deal with their complaints to government regulatory agencies of not treating them correctly. (This is not true in every case of long-term pain issues, but we don't have enough pain specialists to help offer alternative treatments.)

Insurance companies make millions in profits (like energy companies), while the complaint of rising health care costs continue. Insurance companies are dictating what they will pay for at the expense of the patient. Who regulates this behavior?

The government requires accredited hospitals to see all patients who come through their doors (this is appropriate), but they did not provide a method of funding for the care of those not able to pay for the care. The indigent population deserves care like anyone else, even with the poor lifestyle choices causing their illnesses and needs. Who pays for that? Everyone else who can afford it, that's who.

That includes the working class, with employers who provide them with insurance, the rich, who purchase their own insurance, and the Medicare system -- funded by all taxpayers. Even the Medicaid coverage of some patients, paying 40 & cent; or 50 & cent; on the dollar, doesn't come close to paying for each visit when the Medicaid patients use ERs for primary care. The Medicaid population in some instances is in the third generation. It was designed as a stop-gap, to help a person over a rough time in life, not to become a lifestyle choice.

With government's track record of enabling, I would not recommend a government-provided health care system. The government has a poor ability to regulate anything they try to control. I would encourage the government to start making Medicaid users responsible for their choices, such as a co-pay to the ER just like everyone else has to pay for -- maybe $20.

Insurance companies should be mandated to bring back insurance coverage options on a private basis to individuals -- catastrophic health coverage to full coverage, with different co-pay options (affordable, of course) -- without passing this on to employer health care plans. Maybe they should even be nonprofit.

We need to bring health classes back to the schools so that, from an early age, students learn about their bodies. If the younger generation can learn to take care of their bodies better than the older generations, that would cut down on the cost of health care.

If the government is going to make universal health care initiatives that cost providers more money, it needs to provide a method of funding. Health care has brought about significant cost-cutting measures, with hospitals using all the techniques they can to cut costs while still providing the best health care in the world. There isn't much left to cut without affecting good outcomes to the patient, which, I am sorry to say, has happened. The day when all a nurse or doctor had to worry about was "What is the problem, and what do we do to fix it?" has long since been traded in for worry about the organization's bottom line. That is not to say we shouldn't be fiscally responsible, but the government has shown it does not have the ability to be responsible, mostly due to its structure and inability to respond to changes as quickly as the private sector does.

From your article, I could only glean that both parties -- as well as candidates running for office -- don't have a real clue about what health care needs. It starts at the grass roots. We need to stop enabling poor behavior, encourage better lifestyle choices, regulate the insurance companies to do what they are supposed to be doing, and that is providing health care coverage to all.

David E. Brown is a registered nurse in Spokane.

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