Your Voice: The next U.S. Surgeon General must be a physician

Dear President Trump,

Congratulations on your first quarter as President of the United States. Citizens elected you, a non-politician, to head our federal government and political system, a daunting undertaking, for sure. We certainly appreciate your approach to individual rights, freedom, liberty, reduction of federal government bureaucracy, decreasing taxes on citizens and fiscal responsibility. To those ends, we support your honest efforts to drain the Washington, D.C., swamp of influence peddling, paid lobbying, special interest payola and career politicians.

The U.S. Surgeon General has always been a physician for more than 200 years. The role began in 1871 as the first Supervising Surgeon of the Marine Hospital System. Later, supervision of the Public Health Service was included. All previous surgeon generals have been physicians. 

As you know, there are two types of fully functional and licensed physicians in the U.S.: MD, medical doctors or allopathic physicians, and DO, osteopathic physicians. Both have 11-plus years of college, medical/osteopathic graduate school, post-graduate internship and residency training, depending on specialty. Nurses have half the training of physicians with four-plus years of college and clinical training. 

As physicians, we recognize the importance of nurses in the healthcare arena. However, here is the job description for the surgeon general of the United States: “The Surgeon General reports to the Assistant Secretary for Health (ASH), who may be a four-star admiral in the commissioned corps, and who serves as the principal adviser to the Secretary of Health and Human Services on public health and scientific issues.” 

The need for scientific knowledge demanded by this job is so much more properly handled by a physician. From the more rigorous undergraduate requirements straight through the substantially lengthier training, a physician is more highly trained to answer questions surrounding scientific issues. 

Imagine if the United States were under attack by a biological weapon agent, or infectious disease engulfing countless lives. Who do you want to handle these urgent situations? 

Therefore, it is not appropriate to have an academic doctorate, nurse or other para-medical practitioner serve as surgeon general. Please consider a DO or MD for the role. We can provide excellent candidates upon request.

Craig M. Wax, DO
Mullica Hill, New Jersey

Free market can fix healthcare cost woes

In response to “Cost, not access, is underlying problem facing American healthcare” (May 6, MedicalEconomics.com), Dr. Koka is correct that the healthcare crisis is driven by the excessive and unfair prices charged for medical services. If a hospital is happy to perform an ECG for the $12 paid by Medicare, then it is unfair for a patient to be charged $1,200 for that same ECG. It is tempting to address this inequity by government edict; price controls to force hospitals to charge every patient the same reasonable fee for the same service. 

This is how the problem of preexisting conditions was addressed by Obamacare, which prohibits insurance companies from considering them.

The problem is that nobody, no matter how smart they are, can set prices or mandate services better than the free market, in the long run. All prior attempts throughout human history to fix prices or mandate services have failed, including Obamacare (its collapse is imminent).

India is no exception, nor is Canada, where patients suffer from excessive waiting times for needed procedures. The rich in England have the option of an “upper class” private hospital system, as an alternative to the rationed care at their National Health Service. Canada’s more stringent single payer system enforces egalitarian care, but still allows the rich to leave the country as “medical tourists,” to receive timely care on a cash basis in other countries. 

The answer is always to provide more freedom, more transparency, more choices, more patient empowerment and more negotiation on prices. Monopolies must be smashed. The best way to accomplish all of this is to introduce free market solutions and competition, and to allow patients to purchase their own tests without the delay and hassle of an overworked doctor in the middle. 

A prescription for any medical item or service should allow the patient to shop around and negotiate his best deal. In the short run, the poor must be subsidized with socialist charity. In the long run, the poor should share in the prosperity created by free minds working in free markets. 

David L. Keller, MD, FACP
Lomita, California