The New York Times ran an op-ed by Dr. Sandeep Jauhar, a cardiologist on Long Island, who is the canary in the mineshaft for doctor discontent.

Doctors are not happy with the state of medicine in the United States. Here is a short and partial list of general complaints:

“Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges. Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.”In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.

“The dissatisfaction would probably not have reached such a fever pitch if reimbursement had kept pace with doctors’ expectations. But it has not.

“Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.”

This may explain why 65% of doctors in the United States want a single payer system. Not being paid for your work, having to fill out paperwork and chase claims would frustrate any doctor, especially if they went hundreds of thousands of dollars in debt to become a doctor, just to fight with a managed care voice on the phone to treat their patient.

Patients with an HSA should pay their doctor cash from the account at the time of the service, and the doctor should give the patient a price that takes into account the fact the doctor is getting paid the day of the visit and that the doctor does not have to chase their payment from the insurance company.

This would go a long way to helping doctors understand why a cash paying patient with an HSA is better for their bottom line, and that the patient is the one making the decision with the doctor, not an insurance bureaucrat who is looking at a computer screen, not the patient.

California’s Single Payer Train Wreck

The Sacremento Bee ran an op-ed that revealed one of the reasons the right-left alliance in California that pushed for universal health care could not even get a bill to be voted out of one Committee in either the California State House or Senate: a $210 billion price tag for the single payer option.

Democrats love the health care issue because the public trusts them more on health care.

Democrats can pound away verbally at the problem without providing a systemic solution that has the legs to actually become law.

In fact, in the past two decades, every major Democratic led health initiative has failed, while two major Republican health initiatives have passed Congress and become law.

Before people get up in arms about the statement above, HillaryCare failed, the Patient Bill of Rights failed, while the Medicare Prescription Drug benefit with the Health Savings Account (HSA) provision became law, and HIPAA, with the Medical Savings Account (MSA) pilot, became law. Democrats were in control of both Houses of Congress, and controlled the White House, during the HillaryCare fight.

One of the reasons that Democratic health care initiatives fail is because the Democrats themselves are divided between those who want a Canadian style health care system, and those who want to use the tax code and other such mechanisms to reform health care. This division contributed to the explosion on the launch pad that was the California health care reform effort.

But ultimately, all health care reforms must pass the “Where is the money going to come from?” test, and the fact is, the most spending by the U.S. government on any single thing is on health care — specifically on Medicare, Medicaid and the tax break for employer health plans. The total expenditure on those three items is north of $1 trillion a year.

The fact of the matter is that the money for health care reform, will most likely come from the money the U.S. government now spends on health care.

This will make the job of any health care reform plan, even more difficult, and is likely to result in no reform becoming law anytime soon.