Healthcare Reform–What would Reagan do?

IMAG0130 Today, I will give a luncheon keynote at the annual Council on Employee Benefits gathering at the Four Season’s Hotel in Westlake Village in the suburbs of Los Angeles.  Last evening, I joined the group for what turned out to be a very memorable evening at the Ronald Regan Presidential Library and Museum in Simi Valley.  It was an absolutely beautiful evening and a very special treat to literally dine beneath the wings of Air Force One.  If you ever find yourself in the area, I would highly recommend a visit to the Presidential Library.IMAG0124

Being at the library and museum after hours afforded an opportunity to really  examine the memorabilia, life, and times of President Reagan.  Regardless of political persuasions, I think most of us would agree that Ronald Reagan was not only a charming man, but someone who lead an extraordinary life.  It got me thinking about the situation in which we presently find ourselves.  What will it take to extract America from this terrible economy?  How much of it is due to sins of the past come home to roost versus fear and doubt about the future and our ability as a nation compete globally?  And what about healthcare?  What kind of system do we really want?  Do we want a system that provides a safety net of care for everyone?  Or do we simply limp along and make some minor adjustments?  Remember, that one in eight American jobs depends on healthcare.  In every town across America, healthcare is one of the top employers.  We will be tinkering with a system that is a significant force in the American economy.

Other developed nations manage to provide a safety net for citizens and do so for far less per capita than we presently spend in America.  We can have universal care and we can have more affordable care, but it is also important to level set on what that really means.  It does not mean that everyone gets everything they want any time they want it or need it.  It wouldn’t mean that everyone has access to the most expensive and heroic treatments.  It is not likely that million dollar cancer regimens, organ replacements, and bionic limbs could be provided to all.  Certainly we would need to adjust our expectations about care at the end of life.  The emphasis of our healthcare system would need to shift away from sick care and focus more on prevention.  There would likely be some kind of rationing of the most expensive and experimental treatments based on co-morbid disease, life expectancy, and other factors.  We couldn’t just demand treatment no matter what the cost and expect government to pay for it.

IMAG0148Here at the CEB event, where the setting is truly inspiring, there is a lot of focus on what will happen to  healthcare in America.  Will health insurance through employers continue to be the model?  You may be surprised to learn that even in many European nations that have socialized healthcare, private insurance is frequently in the mix and often provided through employers.  Private insurance exists because people want more than the government can or will provide for them.

I don’t claim to have an answer about what kind of health system is best for America.  There are advantages and drawbacks to every system around the world.  It is clear that we need some kind of change.  The question is will we be better off, happier, and healthier as individuals and as a nation when that happens?  Time will tell.

On a related note, you may enjoy reading a piece from my colleague Peter Neupert on his Blog Neupert on Health.  It is entitled “Tear Down the Walls and Liberate the Data”.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation 

Comments (9)
  1. Bill

    How have you been? Your site looks great! Drop me an e-mail


  2. hlthblog says:


    I would be delighted to "drop you an e-mail" but I don’t have your address.  You can reach me at

    Bill Crounse, MD

  3. Bradley says:

    I think Reagan would have developed something similar to in Seattle. Did you see their press release yesterday? This is the obvious answer for uninsured and under-insured Americans. Pay cash and receive a large discounts for consumers. It helps the provider by saving on staff time and effort to collect long awaited reimbursement. At the same time, it saves money for the patient. Makes perfect sense for families, invincibles (ages 19-30) and unemployed…and is a win/win deal. Consumers can bid, make offers, and name their own price, i.e. eBay model. Here’s the press release:

  4. hlthblog says:

    Thanks for your comment, Bradley.  I’ve long been an advocate for price transparency in healthcare services.  Such transparency is needed not only for people without insurance.  We need it for everyone who purchases healthcare services whether by cold hard cash or their insurance dollars.  I’ll be following your good work.

    Bill Crounse, MD

  5. Mona Lori says:

    I am dedicated to promoting price transparency in our health care sytem.  In an effort bring price transpareny to consumers, I launched, a search engine to help consumers look-up out-of-pocket prices for health care services.  The site collects prices from consumers, providers, Government and crawls public websites that publish prices.

    Mona Lori, Founder,

  6. Sui Generis says:

    This is the silliest thing I’ve ever seen. Wow, you are told you have cancer and need immediate surgery to prevent more damage to your spinal cord. So you’re going home and check on pricing so you can pick the lowest cost doctors? But you may not even know what type of cancer you have.

    But you are going on sites like some of you have touted to see what others have paid, none giving their locations, and call up the oncologist your were referred to and ask his charges? And you will pick the least costly? Right. Why not put and ad on Craigs list and invite bids, perhaps giving your preferred locale. Or try EBay.

    Your kid has a stomach ache which won’t stop. You will call all the pediatricians in your area and ask how much to fix it? Or you take him to the ER, after calling around to find the cheapest, and when they tell you it’s appendicitis and he needs surgery, you will say "How much? Thanks, I’ll get back to you when I get a few more prices."

    Or you think it’s just for tests. Great, and then if they see some polyps, they need to ask do you want them removed; that costs extra. How many do you want removed?

    For office visits, you will pick on price, not someone you are comfortable with, who knows your history and you feel is a good diagnostician? So, if he price increases will you drop him and shop for someone new?

    And those kids who are going without insurance – do you realize that one third of those between 25 and 35 are living at home with their parents because they can’t afford to live on their own? They and the unemployed should just pay cash? Out of what? They HAVE NO MONEY.

    Wow, what a bunch of witless, wealthy, wankers!

    People aren’t widgets, and illnesses don’t fall in neat little categories. There is no way to pre-price diagnosis and treatment because each case is individual.

    And these "remedies" don’t touch the biggest problem, when doctors tell you you need a procedure, whether test or drug or surgery and you don’t. Where there are alternatives that may be better for your pocketbook and your health, rather than benefiting your doctor’s pocketbook.  How do you know? How does the average person decide that their condition will resolve on its own or with conservative treatment rather than rushing into surgery?

    Inappropriate Dx and Tx are what really raise costs, and they are 99% under the doctor’s control.

    Doctors need to clean up their acts (and discipline the out of line doctors) rather than dumping the responsibility on their victims, I mean patients.

    That close to 200,000 die EACH year from preventable medical error, and that doesn’t begin to touch the number that are injured by their medical care demonstrates conclusively that doctors and hospitals and other health care personnel need to clean out their Stygian stables first.

  7. hlthblog says:


    Thanks for your comments.  I’m not sure that I’m seeing the connection between what you ranted about and the topic of this blog piece.  None-the-less, debate is good.

    Bill Crounse, MD

  8. peggy says:

    i do pay cash whenever possible it keeps the cost down and the premiums down and if more people did that what a cost saver it would be but also have some form of catastrophic ins. because things do happen in life a young person whom likes to mountian climb should have an ins, policy that pertains to his life style and so fourth and so fourth. lets all get off of the governments teet the milk is sour and has no real benefits. please be responsible for your own healthcare eat right workout and do your best to stop habits that will eventually kill you although i believe thats a persons, own personal choice but don’t ask anyone else to pay for your own doings. simple and no government takeover of your life you preserve your freedoms and the rest will follow suit freedom is the answer and personal responsiblity will fix things immediately

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