An Open Letter to the President of the United States

Dear President Obama,

Having watched your State of the Union Address Wednesday, I was inspired by your call for ideas to address Health Care Reform. I, via this letter, would like to submit my thoughts and ideas for consideration and debate, with the intention of finding a path to a solution that meets the needs of all Americans with regard to available and affordable access to health care.

First, I would like to state that I have read through as much as possible, as published by both partisan and non-partisan organizations, research and details of the provisions outlined in H.R. 3962. I believe that bill to be quite aggressive at attempting to reform the health insurance industry in the United States. I also see that much of the controversy and divisiveness you referenced in Washington is, truly, putting a blockade in front of progress toward a solution. However, at the same time, I would caution that dissenting viewpoints to a presented bill (any bill, introduced by any author or committee), in any house of Congress, does not explicitly translate to a lack of desire to do the necessary work. A “NAY” vote on H.R. 3962 should NOT be politicized to suggest that a person or party is against health care reform. They are merely voting against THIS bill’s solution. To suggest otherwise is exceptionally divisive in a country where divisiveness has already torn away the fabric of healthy, progressive debate and dragged it down to an ideological Civil War of Words where the dirty weapons of politics such as personal attacks, “fear-mongering”, distortion of truth, and in some extreme yet unfortunate incidents, violence or the threat thereof. I am not talking about Congressmen and Congresswomen. I’m talking about everyday average Americans. For the Joe-the-Plumbers to the Brad-the-IT-Guys of America, our “Leaders” in government, all parties, and honestly, all branches, have given us the example of bickering, finger pointing, name calling and posturing to follow. This is clearly unacceptable.

Elected officials are servants of the public, their constituents. This means all of them, not just the ones that voted for them. The arrogance and narcissism must be dealt with. You were elected on the promises of hope and change for a better America. Millions of people voted for you. Millions did not. You must lead them all. You represent all of us. You need to lead - ALL of us. Naturally, as you said in your speech, there are deep seeded differences in ideology and philosophy across the political spectrum. My expectation from you, from Congress, from all elected officials down to the school board members to the local alderman in the smallest American hamlets is that a consensus can be attained, differences set aside, personal grudges eliminated, partisanship be damned and the progression of work toward the betterment of America be the one and only standing objective of the offices which you hold.

We are in a political society now where we have few choices come Election Day. We are in a society where we must choose elephant or donkey, red or blue, Democrat or Republican, and the nature of these party politics makes our support of any candidate backed by these parties a label. I voted Republican, therefore, in the public mind, I MUST be anti-gay rights, I MUST be pro-oil company, I MUST be a member of the “Religious Right”, I MUST be anti-health care reform, I MUST be a hard-line conservative. Similarly, I voted Democrat, therefore I MUST be Pro-Choice, I MUST believe in Tax-and-Spend, I MUST be anti-Military, I MUST be a hard-line liberal. This label concept is clearly on display in Washington politics. That attitude transcends the walls of the Capitol Building and White House, and seeps into the public psyche. These labels go further in countering any progression toward diversity of thought, understanding, mutual respect and agreement on the common goals of all Americans. They hinder our elected officials from truly understanding the complexities of philosophy of their constituents’ mindsets, beliefs, principles, and needs. But today, my choice is Team Red, “all-in” or Team Blue, “all-in,” and I am identified and classified by those narrow options. That is EXACTLY why Americans across the country are looking at their elected officials, even the ones they voted for, and still ask “but who truly represents me?”

Respectfully, Mr. President, I’d like to return to the topic of health care in America. I believe that we have exceptionally high quality of health care in this country. I believe that trusting your doctor and trusting your hospital is instinctive to most Americans. We believe in the health care system. We believe in the doctors, the medicines, the procedures and the technologies so much that when we do have a need to visit a physician, if he or she tells us to “take two of these and call me in the morning”, we do it knowing that is what will work the best toward fixing what hurts.

What has been the primary topic of political, economic and social concern is not America’s health care system. It is the cost of America’s health care system. I often try to use a very simple example when discussing with my friends where I perceive the root of the problem to be. Why does it cost $10 for a single dose of Tylenol at the hospital when I can go to a drug store and buy an entire bottle for less? Extrapolate that inflated pricing to the more complex medicines, specialized doctors, and complicated technology and it is any wonder the cost of health insurance is so high? Digging deeper into the causality, we need to truly understand the pricing of the health care and address that before, or concurrently, with dealing with the cost of the insurance. Another hot topic relates to the concepts of a pre-existing condition. Insurance companies price their products on the basis of risk. Because people with pre-existing conditions are at high risk for requiring more and more expensive health care than someone without, insurance companies will either charge massive amounts of money to cover them, or decide the risk is too great to cover them at all. This is certainly tragic. However, I would put to your consideration that if the cost of the care itself was better managed and less inflated, the risk analysis is fundamentally changed, suddenly making an insurance company’s pricing structure more manageable to the patient.

Now, don’t get me wrong, I would not suggest that the current situation exists absent of blame on the health insurance industry. What I am suggesting is a closer examination of the cause of the high costs of health care and its effect on the high costs of health care insurance. I also would not suggest that addressing the cost of health care alone would then immediately make the insurance available and affordable to every American. I am simply proposing that it will take more work to follow the cause and effect flow back upstream to truly understand and make intelligent choices about how to deal with the problem.

Mr. President, the following represents some personal thoughts to begin to address the cost of health care, and why insurance is still difficult, expensive, or impossible to obtain for many Americans.

- Require that the health care industry publish a rate schedule for their services so the public can better begin to understand the costs. If you cannot measure it, you cannot manage it.

- Investigate the feasibility of a “cap” on Malpractice Lawsuits. Detractors to this idea might suggest this could devalue the life or livelihood of the victim of malpractice, but I put to you that no amount of money truly defines or replaces the unfortunate injury or worse, loss of a loved one due to malpractice.

- Considering our intention of ensuring available, affordable health care to all Americans, perhaps think about mandating that heath care services be treated more as utilities than free enterprises, removing the risk of profiteering from health care, and helping to drive down costs.

- Consider grant-type funding for research, development and innovation in the health care medicine and technology sectors, allowing these organizations to provide the tools to health care organizations without needing to collect extra revenues to fund R&D. This would certainly include academic institutions. This can help drive down the cost of that new X-Ray machine or that new prescription drug for the hospital. If it costs less for the hospital to purchase, it should cost less for the patient to use it.

- Consider setting a baseline for basic preventative care costs. For example, a yearly visit to the doctor for a physical, blood test, cholesterol test and blood pressure reading should not break the bank, nor be radically different between doctors. Combined with published rate schedules as mentioned above, it allows the public to choose in an informed and educated way how to use this service, and it allows an insurance company to better price coverage for this basic need.

Mr. President, these are merely a couple examples of ideas that could constitute outside-the-box thinking on dealing with the problem of health care costs in America. These ideas might be impossible, impractical, controversial, tried and failed, or even currently in consideration. What I am attempting to encourage is to look deeper into the problem to find the basic root cause of it instead of focusing on the symptom. Ask the question, “why is health care insurance so expensive or hard to get and keep,” and follow the answer down the path to a solution. It is not so simple that it can be summed up to the greed of the health insurance company, although there may certainly be cases where that is a contributing factor. We cannot fix the problem by subsidizing the insurance without attacking the root cause.

The American people believe in each other. That is the spirit of America you alluded to in your State of the Union speech. They want to believe in the government. They want to believe that the government will act in their best interests in order to solve the problems we face today of unemployment, national security, financial security, and providing an America that is a beacon to the world in the name of freedom and liberty. Where our children and their children can grow up knowing that they live in the greatest country in the world because it is a country of the people, by the people and for the people, and our elected representatives never forget it.

In closing, Mr. President, please encourage yourself and your fellow Washington representatives to the American people to remember and live by the essence of why we are here and what we believe in.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Sincerely, your constituent,

Brad Kostreva