Eyeworld

142 | EYEWORLD | APRIL 2019 O UTSIDE THE OR by J.C. Noreika, MD, MBA Contact information Noreika: jcnmd@aol.com INSIGHTS and wealthy. It can redesign healthcare's opera- tions and economic underpinnings to provide citizens access to timely care at appropriate prices. This is a political problem. Its solution re- quires cooperation, collaboration, accountability, and equitable sacrifice. Choices must be made, compromise em- braced. Efforts by Washington's leaders fail because they endorse an over-engineered, top- down design promoting an inflexible solution that overpromises and underperforms. Alternatively, a Darwinian crucible of competition would critique capitalism and socialism's best ideas on a state-by- state basis and gauge efficacy and value. Envis- aged by the Founders, these regional incubators would generate and share best practices. National and state medical organizations proselytize the importance of big data. Might membership be served if ideas debated in exam and waiting rooms among staff, patients, and families were aggregated and collated on organi- zational websites for analysis and comment. Ideas could foster position papers to initiate pro-active narratives with legislators and their health admin- istrative assistants. Social media could be used to shape public opinion spawning bigger, broader ideas. Capitalist or socialist, we know what doesn't work. A third way? A constructive revolution driven by empirical reasoning solicited from healthcare's end-users and producers. It is time. We must lead or risk irrelevancy. I n July 2017, The New York Times published an article titled "'Medicare for All' Isn't Sound- ing So Crazy Anymore." Senator Bernie Sanders' signature proposition will likely assume center stage in the 2020 presidential campaign. Advocates will support healthcare as an inalienable right. Opponents will vilify single-payer as socialized medicine. His plan redistributes wealth and income. But is it socialism? Socialism co-opts the means of production. Think Britain's NHS control of hos- pitals and employment of doctors, Cesar Chavez's nationalization of Venezuela's oil industry, and Xi Jinping's appropriation of banking and heavy industry. "Medicare for All"? Technically, no. "Medicare for All" does not contemplate requisition of hospitals and clinics and compulso- ry employment of physicians. It does not directly commandeer the means of healthcare's provision. But the conversation has tilted leftward. Senator Kamala Harris foresees little future for private health insurance. Since more than half of all Americans receive coverage through that market- place, her prediction of its demise is premature and improbable. Physicians find themselves in a ticklish situa- tion. They are the means of production and con- tend with fallout from an industry that keeps 28 cents of every dollar spent on health insurance. Electronic health records, mandatory recertifica- tion, practice protocols, and other governmental intrusions threaten autonomy and infringe upon the patient-physician covenant. Bureaucracies dictate reimbursement—in effect, income—but offload business risk. A recent letter to the editor of the Wall Street Journal declared this is not social- ism but fascism. The dialectic engulfs the globe. An article in The Economist reports that income inequality in the U.S. after transfer payments and taxes has changed little since 1985 yet opponents disparage capi- talism as increasingly unfair and corrupt. Critics of socialism cite the postal service, AmTrak, the Veterans Administration, and more as examples of governmental inefficiency, waste, and unre- sponsiveness. Is there a third way? The United States is innovative, creative, technologically sophisticated, A third way About the doctor J.C. Noreika, MD, MBA Philadelphia ASCRS member for more than 35 years For more on this topic, be sure to catch the Government Relations symposium, "Is This the End of Fee-For-Service?" at the ASCRS ASOA Annual Meeting on May 5 from 1:00 to 2:30 p.m. The session will feature Harold Miller, MS, and Steve Forbes, MA.

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