Dear Santa letter 2008

Dear Santa:
This is truly a monumental moment for me. Being Jewish, I have never had the urge to write to you, but in the spirit of "change" and crossing over, I had this overwhelming need for audacious hope and a prayer. Being Jewish, I accept the stereotype of sometimes arriving late to the party. That said, my wishes are priceless if not timeless.

My list is short. I am only asking for reason and sensibility to come to our nation and our leaders. And, if you'll throw in ethical behavior and a sense of morality, I'll leave extra milk and cookies.

You see, even as a graduate of Wellesley in Economics, I can't grasp the concept of purchasing a "legal" swap in the face of selling short. Isn't that sort of like buying fire insurance while your house is burning and knowing that with the taxpayer's help, you'll recover your mortgage and enough to buy another luxury condo? I mean, talk about Christmas. Rep. Barney Frank and his buddies in Congress must have had a few too many hot toddies when they were thinking that they could actually regulate and mandate "toxic" mortgages for the poor and get the taxpayer to pay for their "vision."

My concern is that this same "team" is going to continue to make decisions affecting my future and the future of all our children. They are about to embark on decisions regarding the health of the nation.

To date, this discussion about health care reform really has me guessing what medication combination this country has been taking... clearly an overdose. It is not clear how we can rationally discuss "health" insurance. Health is not an insurable commodity. Rather, sickness is the unpredictable event that we might insure and health is an investment, like buying good shoes or wearing a warm coat (with a wool lining in the winter months).

Trying to insure the health of all Americans is likely to bankrupt the nation for sure. Massachusetts, a state smaller than the county of Los Angeles is already in financial trouble and they are only two years into their state system having insured an additional 3% of their residents. Hawaii had to pull the plug this year on its new state-funded health insurance program for children when it found out that virtually all of the children in the program previously had insurance, but their parents had dropped it in order to sign the children up for for the new taxpayer-funded program. (Now you see why I am asking for "reason.")

If you could just inject good sense into Secretary-designate Daschle's brain, maybe he would see the way to suggesting that the government might only provide catastrophic insurance (even in the Medicare program) and only for those who are not able to make their own purchase. I know that you can help our leaders with the intellectual argument that government controlled, population based health care is just not good for any individual person. It is politically correct and very expensive egalitarianism. But, if in the end, the reform we engage is reforming our government mandated insurance opportunities to mean ONLY catastrophic insurance for sickness or accident, we will have allowed for the purchase of valued additional health benefits in a free market. Santa, this is the rational conversation that I am putting at the top of my list of wishes. Americans deserve no less.

Reason would suggest that all Americans should make their own personal investment in their life and in their health. That was the intent of our forefathers when they constructed the constitution and established our protected rights. Those rights did NOT include any obligations on the part of the government to impose the services of hospitals, physicians, or employers to guarantee a level of health or preventive care. Our rights are our opportunities to engage and do not include obligations of any professional to serve us.

If we are going to legitimately engage reform, we must first confirm our duty to deal with confirmed fact. (I guess that is another wish. Could you spread a whiff of intellectual integrity over all the conversations about health reform?) Health is indefinable on a "population basis.” We resort to the discussion about insurance when we really want to talk about affordable accessible care. We have never been able to successfully "sell" health across a population. Let's stop that conversation before it bankrupts us further.

Reason would have us believe that every American deserves health care choices and that those choices should be "value based.” Reason would suggest that we need to make our health care delivery system transparent (that does not mean that the government has a right to any patient's health record). It is time that hospitals and doctors post retail prices. Rational health care purchases can only be made with information about cost and the specific utility for an individual patient.

And finally, Santa, as long as we are "facing the facts,” I would ask that we engage a societal debate about the morality of establishing law that defacto creates a class of citizens who are forced into retirement and Medicare at a defined age. Morally, the nation has decided to pay for the continued "health" for those seniors who are mandated into a (relative) non-productive state of co-dependence. But, that decision fails to protect the working public and sanctions an economically unsound system that robs the elderly of their opportunity for continued productivity and taxes "pre-seniors" far too heavily. That 1965 decision was about power and lacked reason and forethought.

It would seem that any debate about health care reform must include a much fuller discussion about all the social systems the government has mandated since 1965 when the nation established this new sense of moral collectivism… but forgot to fund it. Unfortunately, in that new "morality" the rights of individualism that were truly the basis of our constitution were thrown overboard, much like tea from a ship moored in Boston.

Santa, it is reason, rational thought, and responsible debate that every American deserves to hear in the Congressional deliberations about reforming the means by which we deliver sickness insurance and health opportunities to America’s patients. Most important, please infuse a new sense of respect for the rights of every individual to make their own choices for their health and for their life.

PS: next year… if all goes well, you’ll find physicians’ waiting rooms filled with patients eager to speak with their individual doctor about their personal health choices and that better day that our forefathers dreamt would be every American’s dream: the right to personally invest in life and health in pursuit of happiness.

Marcy Zwelling-Aamot, MD FACEP
562-596-7584
Los Alamitos, California