Health care or not, I’m partisan to a president that can lower my taxes and fix what the housing market “greed” created… Just get the job market back up and avoid more scams…

In my estimation after over 30 years of concerted efforts in health services research to contain costs while improving quality of care, I have come to the conclusion that we are blind to certain fundamental facts of life and remain in denial about them. Until we realize the flaws in two of our assumptions, no reform can work, in my opinion.

First, life is a terminal condition. If we do not come to grips with our mortality and understanding that health care to prolong our time until that certain destiny starts with our own healthier behaviors no reform will work. Further, those among us that are predisposed to a shorter life span due to family history or other congenital "givens" must also come to grips with our variable fixed spans of time we get dealt to us and stop expecting the false promise of medicine to make us immortal can or should be realized. We must learn to welcome our own ends when we know it is our time and leave with dignity and a sense of completion to our calling. Otherwise, the system will continue to expend most of the cost of all the costs we incur in our lives trying to forestall the certainty of dying.

Second, a health system driven by the profit motive cannot deliver what reform expects it too. I long ago read and concluded from the clinical-financial data used extensively to manage care and manage the health system that profits cannot be made from treating sick people. Really sick-as-hell people are a financially devastating effect regardless of how many contribute to the risk pool. The reality of this fatal flaw of the profit motive in health care is illustrated by the fears people have stirred up by being pummeled by extreme groups touting that "death panels will be formed to deny care to Grandma, who will then be forced to a certain death!" Ironically, it is the fear mongers behind these ads who are already at work issuing proxy death sentences motivated by profits! My own brother-in-law, aged 55, just recently lost his insurance in the middle of fighting a hospital-acquired infection following intestinal surgery - MRSA - and then needing another surgery to remove kidney stones that cannot be passed. When trying to get his insurance reinstated on his own, he was told he would have to wait 90 days. The hospital says that unless he can pay the $16,000 the surgery costs, they will not let the surgeon do the surgery on his kidney. By the time he gets re-insured or can come up with the money himself, he could die from the infection or the kidney stones. In my judgment, death panels are already at work under the current system!

In short our society needs to make fundamental changes in its belief system and learn to die well, while the providers and the payers need to accept a much lower profit margin than they have, to date, before any full-coverage reform can work. The food distribution industry - grocery store chains, for example, have long understood that their margins would always be 1-3%. They are just now learning along with the food manufacturers that healthier food might be more profitable in the long run and the right thing to do to keep us all out of the sick-care system longer.

The old saying, "an apple a day keeps the doctor away" might also keep the insurance company away and reduce the pressure to try to reform a system trying to make a profit off of sick people.

The alternatively reformed system then would produce a society where the cause of death for the vast majority of us would be reaching a ripe old age, dying in your own bed at home, suddenly, during sleep. Those of us with terminal conditions before our preferred time to die, but way too costly and medically heroic to save us would be given good spiritual counseling with our loved ones, proper palliative care, and a comforting exit. RIP