Peer-review and self-auditing ring strong in your proposed system. The problem is time and incentives. Time because the supply of primary care physicians is low and we already face access problems with waiting periods of three months or more for new appointments.

Incentives are misaligned; insurers can see the cost and want to cut it, patients are immune to cost and are indifferent, physicians are either purposefully ignorant of costs for ethical reasons or like patients are unaware because a third party is picking up the check and medical device vendors, just like any other salesman, want to sell their product.

Regarding the last point, a lot of their products (and Rx too) are already reviewed by physicians. And also sold to them. AMA is one of the most powerful special interest lobby groups around. There's a conflict of interest here. In line with what you're saying, the review should be conducted by outside parties, but the asymmetry in knowledge makes it difficult for anyone but physicians to review these products. So how do you design a "double-blind" system that avoids bias?

I thought you might like this: http://blog.jayparkinsonmd.com/post/164127912/health-reform-explained-on...

I went point by point chipping away and adding to your proposal and didn't throw out one of my own. Most of my work has been in reform and not recreation. The process is certainly incremental, and one of the things I agree with you on is that we do need to start from scratch.

The industry sometimes reminds me of hundreds of iPod headphone wires all tangled up. It's too much to untangle them, better just buy a new one.

Marcos, Akshay, Dead Hedge - the problem is that many companies do not allow their employees time to relax, let alone exercise. Especially in this economy.

At a former company, I suggested a company-wide 15 minute morning and afternoon walk session. The president of the company laughed in my face and asked who would want to stay 30 minutes extra every day to make up the time.

I calmly replied, "We wouldn't make them make up the time - we would gift it to them." I would have gone on to explain that tired employees naturally lag anyway, but she interrupted to inform me she had another meeting to go to.

This was the same company that shortly before had written me up for "overly direct communication" when I teamed up with department heads to reduce lag in the database system.

Now, this company is, more than likely, silly in the brain pan. But I got the same treatment at almost every other job I've ever worked. There's just not enough "time" in the day to give employees time to exercise or be preventative. Hell, almost everybody smokes - or so my neighbors and coworkers would have me believe.

So you're right when you say we need something portable, the problem becomes what portion of the cost -we- have to pay when we get injured.

I'm STILL recovering from my appendectomy in March - a "simple" surgical operation that left me with a 6" scar and $3,000 worth of medical bills. This was the $3,000 remaining AFTER I'd hit the annual cap, including $1,250 deductible, and the insurance paid their 70-90%.

I can't explain the feeling that left me with. I felt like I'd been let down by the entire system - not only did the surgery not go as planned, the insurance basically left me with 30% of the bill. Not long after that, I was laid off - and was denied unemployment.

Like many of my peers, I'm not able to find a job - so I started my own business. I'm living month to month off of the income that I can pull in as a web designer. The system is not built to handle people in my situation - thank goodness I'm reasonably healthy, or else I would be a major burden on the state, the hospital, and anyone else I'd be shorting.

My perspective is that of a guy at the bottom of the leaky barrel - I'm not part of the leak yet, but I've got that sucking feeling.

My point is - when I see an $8 Asprin charge on my hospital bill, and I know I was the one paying for that $8 asprin until the deductible was met, I can't complain to the hospital, whose billing system is set up to charge for maximum insurance payout. I can't complain to the makers of Aspirn, who have no control over the markup charged. I can't complain to the insurance company, who has created a system in which the ones who know how to play the game earn the most profit. I most certainly can't complain to the doctor.

So who do I complain to? Is it fair for me to pay into a system which is inherently corrupt and unjust?

I don't have answers to these questions... all I know is that our medical care system is primitive. Primitive to the point that it might as well not even exist - because so many cannot afford it, so many do not even use the system.

It's time to burn it all and start over.

-Nick