American Medical Association is again led by a Lexington doctor

June 30, 2015

Steven Stack, a 43-year-old Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.

He will need all of the youthful energy he can muster.

The nation’s largest physician organization has some ambitious challenges, from helping sort out health care reform laws to rethinking medical education and trying to stem epidemics of diabetes and high blood pressure.

Stack is the second Lexington doctor to head the AMA in three years. Ardis Hoven, an infectious disease specialist, was AMA president in 2013. She now chairs the council of the World Medical Association.

“We live in the same Zip code,” Stack said. “But we never see each other in Lexington.”

Dr. Steven Stack, a Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.  Photo provided

Dr. Steven Stack. Photo provided

Stack and his wife, Tracie, a physician and University of Kentucky graduate, moved to Lexington in 2006 to be closer to family in Ohio. He is from Cleveland and got his education from Holy Cross and the Ohio State University.

He is director of emergency medicine at St. Joseph East and St. Joseph Mt. Sterling hospitals. Before moving here, he directed emergency medicine at Baptist Memorial Hospital in Memphis.

When I caught up with Stack by phone Monday, he was relieved that the U.S. Supreme Court had rejected a technical challenge to the Affordable Care Act, popularly known as the ACA or Obamacare.

“If it had come out the other way,” he said, “there was the risk of over 6 million Americans losing their health insurance that they had just recently gotten and throwing the entire delivery system into a whole new type of chaos with no clear path forward.”

The AMA has been generally supportive of the ACA, especially its goal of increasing insurance coverage. That doesn’t mean doctors don’t think the law needs improving.

“But you have to be willing to want to correct it and make it better as opposed to just ripping apart and destroying it,” he said. “If we want to make some things better about it, then we need to focus on those things and not on trying to cut the whole law.”

The ACA has both good and bad aspects, Stack said. A bigger issue is how it and other health-reform laws do or don’t work together. Insurance companies also have regulation and bureaucracy that makes doctors’ jobs more difficult and interferes with patient care.

“We spend too much to provide care to too few people with results that are not as good as they need to be,” he said.

In 2012, the AMA identified several broad areas where it hopes to have an impact over the next decade.

One is medical education. Stack said the AMA has invested $11 million in 11 medical schools around the country to pioneer ways of incorporating new technology, new learning methods and new leadership skills in the training of doctors.

Another big initiative is addressing the diabetes and hypertension (high blood pressure) epidemics through early diagnosis and prevention.

About 86 million Americans are thought to be pre-diabetic, “and nine out of 10 of them do not know they are,” Stack said. With better diet and more exercise in proven intervention programs led by partner organizations such as the YMCA, many pre-diabetic people can be prevented from developing Type 2 Diabetes.

Early diagnosis and disease management also are critical for hypertension, which affects 70 million Americans, or 1 in three adults.

“Those are two of the most prominent and prevalent conditions of chronic health in the United States, and they cost over a half-trillion dollars a year in healthcare expenditures,” Stack said.

“If we can improve the care of those conditions … then we could profoundly improve the health and wellness of the nation, improve their capacity for work and fulfilling lives, and improve the economy of the nation all at the same time.”

Kentucky’s diabetes and hypertension rates are some of the nation’s highest, but Gov. Steve Beshear’s embrace of the ACA, by creating a state insurance exchange and expanding Medicaid, has helped get more Kentuckians treatment for a variety of health problems, Stack said.

Another AMA goal is to help “restore the joy to the practice of medicine,” he said.

Doctors “have so much intrusion from governments and private payers and other regulators in their lives,” he said. “If we want to have a healthier, happier nation, we have to have healthier, happier physicians to partner with patients to make that possible.”


GOP extortionists offer no credible alternative to health care law

October 7, 2013

Any discussion of the Affordable Care Act cannot ignore the elephants in the room.

Republicans fought passage of what they call Obamacare in Congress and were outvoted. They challenged its constitutionality before the Supreme Court and lost. They made it their central issue in last year’s elections and lost again.

Having exhausted all legitimate means for getting their way, Republicans resorted to extortion. Demanding that the nation’s new health care law be “defunded,” they forced a shutdown of the federal government. The shutdown put hundreds of thousands of people out of work, inconvenienced millions more and stopped vital services to some of America’s most vulnerable people.

The GOP insisted that President Barack Obama “negotiate” to sabotage his proudest achievement, a 3-year-old law that a Supreme Court dominated by conservatives ruled was constitutional.

If Obama doesn’t cave in, Republicans threaten to not raise the federal debt ceiling — in other words, refuse to pay bills that they already have rung up. The last time they did that, the economy suffered. If they do it this time, economists say, the results could be catastrophic.

This isn’t just another partisan dispute or Washington gridlock as usual. It is an unprecedented act of hostage-taking by a minority party that doesn’t seem to care who gets hurt.

For four years, Republicans have waged an ideological crusade against the health care reform law based on lies and distortions: death panels! Government takeover! They claim it will explode government deficits, even though nonpartisan analysts predict it will shrink deficits.

Gov. Steve Beshear wrote in The New York Times recently that Obamacare will, for the first time, make affordable insurance available to every Kentuckian. Currently, he said, 640,000 Kentuckians are uninsured.

Beshear also pointed out that a study by PricewaterhouseCoopers and the Urban Studies Institute at the University of Louisville found that expanding Medicaid as part of the reform law would add $15.6 billion to the state’s economy during the next eight years and create almost 17,000 jobs.

The irony, of course, is that the new law is based on conservative ideas.

The philosophy behind Obamacare — requiring everyone to buy coverage from private health insurance companies — was first promoted by the far-right Heritage Foundation as an alternative to government health insurance. It combined market-based solutions with personal responsibility. But once Democrats embraced the idea, Republicans rejected it.

As governor of Massachusetts, Mitt Romney instituted just such a system. One reason Romney lost the 2012 presidential election was that he couldn’t make a logical argument for why the health insurance system that has been good for Massachusetts would be bad for everyone else.

Republicans are desperate to stop the Affordable Care Act not because they are afraid it will fail. If that were the case, they would simply let it fail and then capitalize on that in the next elections.

No, the GOP’s biggest fear is that Obamacare will succeed, just as Social Security and Medicare succeeded. Republicans opposed those programs when Democrats created them, and some factions of the GOP have been trying to undermine them ever since.

Republicans have tried to justify their extortion by claiming that Americans don’t want Obamacare. But when asked about the things the law will do, opinion polls show, most people approve of it. And a substantial majority of Americans tell pollsters they oppose the Republicans’ “defund Obamacare” crusade.

Many Democrats are dissatisfied with the new health care law because it doesn’t go far enough. They think the United States needs a single-payer insurance system, much like Medicare, to provide universal coverage. It works for the elderly; why not Medicare for everyone?

Still, Obamacare is much better than what we have had. It will provide coverage to millions more Americans than were covered before, through more-affordable private insurance and an expansion of Medicaid for the poor (except in states where Republicans refused to accept federal funding for it).

One thing you will not hear from Republicans is a credible alternative to Obamacare for getting this nation closer to universal health insurance coverage. That’s because they don’t have one.


Amid ‘Obamacare’ fight, another vision for health insurance reform

August 6, 2012

Medicare turned 47 years old last Monday. Bill Mahan celebrated by setting up a booth on Main Street to try to convince passersby that America’s health insurance crisis could be eased considerably if everyone had Medicare.

The Lexington retiree collected about 125 signatures for his petition. It asks members of Congress to support proposed legislation that would strengthen Medicare, which now covers more than 47 million seniors and disabled people, and make it the vehicle for providing basic universal health insurance coverage.

But Mahan spent much of his seven hours on Main Street listening to people tell him their horror stories: lack of insurance, inadequate coverage, baffling paperwork, treatment they can’t afford to get and medical bills they can’t afford to pay.

“I’ve heard so many stories, it’s just unbelievable,” said Mahan, 68, who went on Medicare three years ago. “I don’t know what to tell these people.”

What Mahan mostly tells them is that these problems are likely to continue until the United States has a single-payer health insurance system.

Under proposed single-payer systems, private doctors and hospitals would provide health care services, but the government would pay the cost from tax revenue. It is the system used in Canada and most European countries, which the World Heath Organization says offers better care for less cost than the United States does.

President Harry S. Truman proposed a single- payer system after World War II, but business interests fought it. President Lyndon Johnson was able to muster enough political support to create Medicare for seniors, which he signed into law July 30, 1965.

When President Barack Obama and a Democratic-controlled Congress pushed through health care reform legislation in 2010, a single-payer system wasn’t even considered. That was because of opposition from insurance companies, which wouldn’t even allow a “public option” choice.

Instead, we ended up with reform legislation that will cover more people and outlaw the worst insurance industry abuses but still will leave an estimated 23 million people uninsured and do too little to curb rising costs.

Republicans have vowed to repeal “Obamacare” but have proposed no adequate alternatives. Senate Republican Leader Mitch McConnell of Kentucky complains that Obama’s health care law is “Europeanizing” America, but he fails to mention that those European systems provide high-quality, universal care with much less administrative cost and hassle.

The most radical GOP plan, proposed by Rep. Paul Ryan of Wisconsin and endorsed by many Republican leaders, essentially would privatize Medicare. But an independent analysis by the non-partisan Congressional Budget Office found that Ryan’s plan, rather than reducing costs, would increase them dramatically, including almost doubling seniors’ out-of-pocket expenses.

Ironically, Obama’s reform law was based on market concepts developed by the conservative Heritage Foundation. Republican presidential candidate Mitt Romney created a similar — and rather successful — health insurance system for Massachusetts when he was governor.

Single-payer advocates say “Obamacare” is better than what we had, but it just further subsidizes private insurance companies. It reinforces our current system’s fatal flaw: the inherent conflict between businesses trying to make as much money as possible and society’s need to provide basic health care to everyone at an affordable cost.

“Insurance companies don’t improve health care,” Mahan said. “They only add cost and complexity.”

Improving and expanding Medicare would require tax increases, but single-payer advocates think that, on balance, they would amount to far less than we now pay for private insurance that costs more and covers less with each passing year. That has been the experience in countries with single-payer systems.

House Resolution 676, introduced by Rep. John Conyers, D-Mich., to create a single-payer system, has been endorsed by dozens of consumer groups, church denominations and organizations representing thousands of physicians and other health professionals. Advocacy groups include Kentuckians for Single Payer Healthcare (Kyhealthcare.org), Improved Medicare for All (Medicareforall.org) and Physicians for a National Health Program (Pnhp.org).

But without public pressure, the legislation is unlikely to get a fair hearing in the Republican-controlled House of Representatives or the Democratic-controlled Senate. The health insurance industry is just too powerful.

During Romney’s recent overseas campaign trip, the Republican presidential candidate praised Israel for having a healthy population while spending only 8 percent of gross domestic product on health care, compared to 18 percent in the United States.

How does Israel do it? Since 1995, the Jewish state has had a non-profit insurance system heavily controlled by the government that provides basic health care for everyone. Imagine that.

 


Health care reform: a chance to see what works

March 26, 2012

The Patient Protection and Affordable Care Act turned 2 years old last week. This week, it faces a key test in the U.S. Supreme Court, which will hear oral arguments on challenges to its constitutionality.

President Barack Obama’s health care reform law has a curious political history. Originally developed as a conservative proposal and embraced by Republican presidential front-runner Mitt Romney when he was governor of Massachusetts, it is now derided as “Obamacare” by GOP leaders determined to repeal it.

Many aspects of the law have yet to take effect, in part because of uncertainty caused by legal challenges. But, so far, it seems to have been good for people in Kentucky — a relatively poor state with some of the nation’s highest rates of cancer, heart disease and diabetes and lowest rates of private health insurance coverage.

The law forbids insurance companies from discriminating against children with pre-existing conditions, Terry Brooks, executive director of Kentucky Youth Advocates, wrote in an op-ed piece. Adults also will get that protection in 2014.

Insurance companies also can no longer put lifetime caps on coverage benefits, Brooks noted, “so if a child beats leukemia at age 8, she will still be able to get the care she needs if she relapses at age 20.”

Children have received preventive care and immunizations without their parents having to pay out-of pocket costs. Young adults have been able to stay on their parents’ insurance until age 26 while they search for a job that includes health benefits — something that has been hard to find since the 2008 financial collapse.

Kentucky Voices for Health, a broad coalition of more than 250 groups in the state, notes that insurance companies must now cover more preventive care, such as mammograms and other cancer screenings, which results in better health and lower long-term health care costs.

Dr. Gilbert Friedell sees a lot of good potential in the law. The founding director of the University of Kentucky’s Markey Cancer Center started the Friedell Committee for Health System Transformation in 2008 to help facilitate improvements in a fragmented and often dysfunctional health care system.

“My question for those who want repeal is, did you like what we had before?” Friedell said. “What do you want to do instead?”

Friedell said the biggest problem with the health care system is that it isn’t a system at all, but a collection of silos and special interests whose business models are built around fee-for-service. That promotes cost escalation and pays too little attention to prevention, management of chronic conditions and coordination of a patient’s care.

While the Affordable Care Act is far from perfect, Friedell said, it is an important step in the right direction for two important reasons: it provides money and government support for new ideas and methods for improving health care and lowering costs, and it encourages discussion for continuous improvement.

“The key to success will be the active participation of the public and accountability to the public,” Friedell said. “At some point, somebody has to say, ‘How is the system working? How does it benefit the public?’ ”

Too much of the health care debate has focused on costs rather than care and prevention, Friedell said. More investment in prevention would go a long way toward bringing down overall costs.

As an example, he cited figures showing that an increase in colonoscopy exams from 2001 to 2008 among Medicare patients reduced colon cancers and deaths among those seniors by 16 percent. “It shows what we can do,” he said.

Friedell said he thinks the law is flexible enough to help states and communities tailor solutions to local needs as well as to address changes ahead. One such change is the need for more integrated care by a wider variety of professionals beyond physicians, such as nurses, nurse practitioners, physician assistants and even social workers.

That means more teamwork — something that wasn’t happening nearly enough before the Affordable Care Act’s passage two years ago.

“You might as well call it the Affordable Opportunity Act,” Friedell said. “This gives us the opportunity to experiment, to look at new things that might work. Yes, money is a problem. If you focus on quality of care, there’s no question in my mind that it will bring down costs. But it has to be given time.”


Report details health reform’s impact on Kentucky

August 1, 2010

Discussion about health care reform has generated a lot more heat than light. Much of the controversy has been grounded in politics, but the new federal law can be complex and confusing.

After all, the whole subject of medical insurance and public health care policy could qualify as rocket science, if only rockets were involved.

A report published last week explains in clear, plain language how the new law will affect Kentuckians. It was put together by Kentucky Voices for Health, a coalition of nearly 100 groups including AARP Kentucky, the American Cancer Society, the American Heart Association, the Kentucky Council of Churches and the Catholic Conference of Kentucky.

The report paints a generally positive picture of how the law will affect Kentucky, the 47th-poorest state in per-capita income, at only 80 percent of the national average. And it provides an interesting group of statistics to show why reform was needed in Kentucky.

The report says that an estimated 626,000 of the state’s 4.3 million people didn’t have health insurance last year. About 80 percent of them have jobs, but many of those jobs are part-time or low-wage and don’t include health insurance. Only 41 percent of Kentucky employers with fewer than 50 workers offer health insurance.

The report cites surveys conducted by University of Kentucky researchers that show that uninsured Kentuckians are three times more likely not to go to a doctor, twice as likely to skip a medical test or doctor-recommended treatment, and twice as likely not to fill a prescription than Kentuckians who have insurance.

How will the Patient Protection and Affordable Care Act of 2010 help Kentuckians?

For one thing, the report said, insurers will now be barred from denying coverage to people, including 920,000 Kentuckians, with pre-existing medical conditions. That part of the law takes effect Sept. 23 for children and will include everyone by 2014.

Expansion of Medicaid eligibility for poor people will extend coverage to an estimated 261,000 Kentuckians — or about 40 percent of the state’s currently uninsured population — by 2014, the report says.

The law will allow 16,800 young adults in Kentucky, up to age 26, to remain on their parents’ insurance policies if they don’t have coverage available through their own employer.

That’s a big deal. Not only has the lagging economy made the job market tough for young adults, but more and more entry-level jobs don’t include health insurance. Nationally, about 30 percent of young adults now lack health insurance coverage, according to the U.S. Department of Health and Human Services.

The new law helps older people in two important ways, the report says.

There will be gradually better coverage for people who now fall into the Medicare prescription drug program’s “donut hole” of cost-sharing. The report estimates that this will apply to 129,000 Kentucky seniors next year. In addition, about 63,200 Kentuckians will benefit from a reinsurance program for early retirees who are not yet old enough for Medicare.

The report also notes that, by 2014, the law will provide tax credits to 221,000 Kentucky families and 51,500 small businesses to help cover the cost of health insurance.

You can download the report and find more health care information and resources at the coalition’s Web site, www.kyvoicesforhealth.org.

It remains to be seen how well this new law will deal with some fundamental problems, especially rising costs, in the nation’s health and insurance systems. But this big first step in what is likely to be a long, continuing process of health care reform promises to at least put care within the reach of more Kentuckians.


Group helps citizens improve Kentucky health care

June 13, 2010

Just thinking about America’s health care and insurance system can make your head hurt.

Our system costs too much, doesn’t work well enough and leaves too many people out. The new reform law includes more people, but it doesn’t do enough to improve care or rein in costs. It was little more than a first step in what is sure to be a long journey toward making health care more effective and affordable.

What should the next steps be? That is what the Friedell Committee for Health System Transformation is trying to help Kentuckians figure out.

The committee is named for and headed by Dr. Gilbert Friedell, director emeritus of the University of Kentucky’s Markey Cancer Center. It hopes to do for health care reform in Kentucky what the Prichard Committee for Academic Excellence did for education reform: engage Kentuckians, not just experts, in finding better ways to do things.

Part of the problem is that, unlike education, health care isn’t so much a system as a disjointed collection of business sectors. Many profit by exploiting the system’s inefficiencies or by providing services, not by making the system more efficient or improving health. Medicaid and Medicare, the government programs for the poor and elderly, have a huge influence on everyone’s care — and cost of care.

The Friedell Committee is a non-partisan, non-profit group of 50 people from across Kentucky. Some are health care or social service professionals, but most come from other walks of life. Many are retirees who have expertise, but no vested interest that they must represent. They research problems and possible solutions and urge community education and action.

The Friedell Committee began in 2008, but its creation goes back to 1992, when state and national leaders first started talking seriously about health care reform. Public hearings in each of Kentucky’s 15 area development districts attracted 5,000 participants; their recorded comments were collected into a 2,000-page transcript.

Friedell said an analysis of that transcript led to the group’s 10 value-based principles for health care reform. Those include making health systems accountable to the public, and making health professionals responsible for providing safe and effective care.

Among the committee’s other principles: Individuals and families should have fair and equal access to high-quality, high-value and affordable care. Patients should be treated with respect. Individuals and communities must share responsibility for health and the cost of care.

As with education, Kentucky has many health-care challenges. Kentuckians eat too much, smoke too much and exercise too little, putting the state at or near the top of national rates for cancer, heart disease, diabetes and premature death. The challenge isn’t just treating illness, but promoting healthier lifestyles.

Because this is a relatively poor state, one in five Kentuckians is on Medicaid. Because of changes in federal legislation, that number is expected to be one in four, or about 1 million Kentuckians, by 2014.

I attended part of the committee’s semi-annual meeting last week in Lexington, where working groups discussed issues they are investigating. One group is working with Kentucky hospitals to track hospital-acquired infections, which kill many patients. Another is looking into team approaches for providing primary care at lower cost. Federal legislation provides incentives for developing such new models of care; 44 states now have demonstration projects, but Kentucky isn’t one of them.

The committee just launched an effort to find at least one “success story” from each Kentucky county for improving health care, fitness or nutrition. The hope is that publicizing those stories will inspire other counties to copy or adapt them.

For more information, go to the committee’s Web site: www.friedellcommittee.org.

“We don’t claim to have all the answers,” said Carolyn Dennis, the committee’s executive director. “We just want to empower citizens to ask the right questions.”


Discussing health care reform, without the hysterics

October 5, 2009

It’s no wonder people are frustrated by the debate over health care reform.

The issues are complex. None of the proposed solutions is perfect. And, more often than not, the arguments seem to dissolve into emotional oversimplification.

Besides, there’s a lot of money at stake. Whole business models have been built around the inefficiency of America’s health care industrial complex.

Last Thursday, the Lexington Forum hosted one of the better discussions I’ve heard on the subject.

The panelists were Dr. Michael Karpf, the University of Kentucky’s executive vice president for health affairs; Dr. John White, president of the Kentucky Medical Association; and Melodie Schrader, executive director of the Kentucky Association of Health Plans.

Some points of view weren’t represented, and the discussion lasted only an hour — not nearly long enough to do the subject justice. Still, it was enlightening.

Here’s what I took away:

The key issues are access, cost and quality. Some people want to change the entire health care system. Others want to preserve the status quo — or at least their current coverage or company’s profits.

But the key is figuring out how to control costs, maintain the quality of care and provide access to more of the millions of Americans with little or no access to affordable health care.

Karpf noted that a significant portion of uninsured Americans are young working people. That’s because employer-sponsored health insurance is becoming more scarce because of costs.

America has too few doctors, especially in small towns and rural areas. White estimated that Kentucky needs 2,300 additional doctors to meet national standards.

Many of us will have to give up something. Increasing access and controlling costs will mean people who have insurance now will have less freedom to choose expensive procedures that have little proven effectiveness.

They also won’t be free to forgo coverage. Schrader said the only way to guarantee that everyone can get access to insurance is to require everyone to have it.

Health care companies and insurers must give up some profits. For example, White said, Medicare Advantage programs — enacted during the Bush administration and criticized as government subsidies for insurance companies — should be eliminated, with the money going directly to pay for more Medicare patient care.

Malpractice litigation must be addressed. Republicans see tort reform as a panacea; Democrats dismiss it as insignificant. But the fact is many doctors feel compelled to order expensive tests and treatments of questionable value for fear they’ll be sued if they don’t.

A better balance must be found between protecting patients from medical malpractice and forcing doctors to practice costly “defensive” medicine.

We can’t be distracted by sideshows. For example, some reform critics warn that government bureaucrats will overrule doctors’ medical judgment. White said that is done too often now by insurance-company bureaucrats.

Another sideshow is the debate over coverage for illegal immigrants. As Karpf said, they’ll be treated one way or another to some degree — and somebody will pay for it. They’ll come to emergency rooms after accidents, when they are about to deliver babies or when suffering with serious illnesses or communicable diseases.

We must take more personal responsibility. Karpf noted that the health care economy now is based on fee-for-service, rather than prudent management. That encourages more spending.

Plus, he said, there’s not enough incentive for patients to live healthy lifestyles and make wise choices.

One key to lowering health care costs is to make the cost structure more transparent — and personal. People will use health care services more wisely if they see it’s in the best interest of their own pocketbooks.


A world view on America’s health care debate

September 1, 2009

The national debate over health care reform is clouded by ideology, distortion, old myths and misinformation, especially when it comes to the way health care works in other countries.

T.R. Reid, who for many years was a foreign correspondent for the Washington Post, tries to cut through some of those with solid reporting in his timely new book: “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”

Click here to read a Washington Post op-ed piece by Reid that gives an overview.  Click here to read Business Week magazine’s review of the book. Click here to listen to an extended interview Reid did with National Public Radio.


Fear “socialized” medicine? We’ve had it for decades

August 20, 2009

There’s a fascinating audio clip on YouTube. It’s from a 1961 phonograph record in which a politically ambitious entertainer named Ronald Reagan tries his best to scare people about “socialized medicine.”

The threat he warns about is legislation to create the program we now know as Medicare.

So here we are, nearly a half-century later, with talk radio entertainers and some Republican politicians trying their best to scare people about “socialized medicine.”

They see a threat in almost any meaningful reform of America’s inadequate health care insurance system.

Some of their scare tactics, such as baseless claims about plans for “death panels,” are truly outrageous. Former Alaska Gov. Sarah Palin might actually believe some of the crazy things she says, but other GOP leaders who lend legitimacy to such hogwash are simply seeking political advantage. They seem to have no interest in improving health care; only in seeing President Barack Obama fail.

What makes the recent tone of the national health care debate so ridiculous is that Americans have had “socialized medicine” for decades, and it has worked pretty well.

The popular Medicare program that Ronald Reagan warned against — and later tried to deny he ever opposed — covers 43 million people who are disabled or age 65 and older. Then there’s government health care for veterans and insurance for public employees. Members of Congress have especially good government health care plans.

My biggest fear about health care reform is that we won’t get any. My biggest concern about Obama’s approach is that it isn’t ambitious enough, especially now that he seems willing to give up on a government insurance option.

There are many improvements that can be made in our current system with electronic medical records and various cost-containment strategies. But I think the long-term solution is some form of single-payer health insurance involving privately delivered medical care — like Medicare.

Why wouldn’t it work to open Medicare, or something like it, to more people? That could provide a safety net. Then, individuals or groups could buy supplemental private insurance if they wanted more coverage and could afford it, as Medicare recipients often do.

Every major industrialized nation except ours has some form of universal health care. Are the “socialized medicine” systems in Canada, Australia, Britain and other European nations perfect? Of course not.

But here’s what you see in the United States that you don’t see in those countries: millions of people with no health care coverage. That includes nearly 600,000 Kentuckians, or 14 percent of the state’s population, according to U.S. Census estimates.

Here’s what else you don’t see in those countries: Millions more people who are scared of losing health insurance coverage if they get sick or lose their job. People who can’t get coverage because of “pre-existing” conditions. And people who see their life savings depleted because they get sick.

You also don’t see businesses struggling to pay spiraling health care costs for employees and retirees while trying to compete in an increasingly global economy with foreign businesses that don’t bear such burdens.

Talk show entertainers and Republican partisans have done an effective job of whipping up the frightened, ill-informed citizens we see at public meetings and protests across the country.

But if they want to rant about “socialized medicine,” they should put their money where their mouths are.

Members of Congress who oppose a government health insurance option for citizens should give up their own government coverage. Let them try to buy a similar plan in the private market.

Then they, the media hacks and other self-described “freedom-loving conservatives” should march down to their local Medicare office and renounce their “socialized medicine” benefits, now and in the future.

Yes, I know. Fat chance.