President Obama told Congress he would not sign a health care bill that added any amount to the national debt — a criterion he does not use when considering escalating war in Afghanistan or bailouts to banks. In a recent article for Tikkun, Dr. Arnold Relman argues that there is no way to meet that criterion unless health care reform includes eliminating the profit motive from medicine, including licensing doctors so that they get a fixed salary each year rather than, as now, making profits from prescribing more tests, procedures and visits that increase their incomes. He writes:
There are two interrelated critical issues in health reform right now: how to extend and improve insurance coverage, and how to control the unsustainable rise in health care expenditures. Virtually all of the current legislative attention is focused on the first issue but, notwithstanding claims to the contrary, none of the proposals now on the table offers any credible solution for the control of rising costs. Without control of health cost inflation, the present system will not be viable much longer.