Letters to the Editor  |   August 2010
Understanding Insurance: Will a Public Option or Co-op Get Us Where We Want?
Author Affiliations
  • Todd R. Fredricks, DO
    Amesville, Ohio
Article Information
Medical Education
Letters to the Editor   |   August 2010
Understanding Insurance: Will a Public Option or Co-op Get Us Where We Want?
The Journal of the American Osteopathic Association, August 2010, Vol. 110, 423-485. doi:
The Journal of the American Osteopathic Association, August 2010, Vol. 110, 423-485. doi:
To the Editor:  
I greatly appreciated Dr Debra A. Smith's thoughts as presented in her editorial, “Understanding Insurance: Will a Public Option or Co-op Get Us Where We Want?,”1 published in the April issue. Her most salient comments are included in her conclusion, in which she stated: 

It seems a violation of the current Medicare contract with Americans to take on additional public health plans when we do not have foreseeable means of paying for obligations already promised to the insured.

Dr Smith is correct. The US government simply does not have any possible means of paying its current healthcare obligations, including Medicare, for the projected number of Americans that will soon be seeking care. Indeed, a private entity that offered such a new medical insurance product without having the fiscal reserves to reasonably honor projected claims would, at best, fail in the market and, at worst, likely be subject to numerous prosecutions for felony law breaking. 
It is deeply disturbing that JAOA—The Journal of the American Osteopathic Association is not regular publishing clearly written articles describing the fundamental economic realities of US healthcare. As illustrated by a letter that I recently received from an osteopathic medical student who disagreed with comments I wrote in the December 2009 JAOA2 that were critical of the economic fallacies in the Obama healthcare plan, some people in our profession have no idea how medical economics work. The student's words were emotionally scathing but not grounded in mathematical reality. 
Since I received that letter, new estimates by the Congressional Budget Office,3-5 released in March 2010, show that “Obamacare” will not be deficit neutral, as its supporters had claimed. In addition, if past performance of government-run programs is predictive, the healthcare bill signed by President Obama will end up costing Americans substantially greater amounts of money than originally projected. 
We are training and graduating hundreds of new osteopathic physicians every year. Many of these DOs enter the market with little or no understanding of how healthcare is funded, how they are to be compensated for their services, what general health insurance products are available, or what it takes to operate the business of a medical office in the United States. There seems to be an idea in our profession that DOs will eventually pick up this information later in their careers. Based on my interactions with colleagues, however, many DOs continue to lack an adequate understanding of these economic and business issues. Frankly, this aspect of the osteopathic medical profession is unethical and embarrassing. 
We owe our osteopathic medical students a clear education on American economics—writ large—with a special focus on medical economics. These students are facing a future in which available capital is likely to dry up. The United States will assume more debt in 2011 than the rest of the world's nations combined, and the federal debt is projected to grow to 90% of the nation's gross domestic product by 2020.4 At some point, inflation from trillions of printed dollars is going to hit the US economy, seriously eroding the basis of our currency. 
None of this is good news, and it is even worse when one considers the unfunded mandates to which Dr Smith refers in her editorial.1 
It is time for the American Osteopathic Association to assume the role of advocate for the education of osteopathic medical students and to demand that all osteopathic medical schools incorporate basic education about medical economics and compensation of medical professionals. We specifically need education on profit and loss, overhead issues, insurance contracts, balancing payer mixes, and loan repayment strategies. Based on my experience working on a personal project involving curriculum development while I was at Ohio University College of Osteopathic Medicine in Athens, I believe that these topics could be adequately covered in 5 to 10 hours of instruction. 
There is no valid excuse for not providing this kind of education, especially considering the economic demands that are growing every day on the osteopathic medical community. 
Let us hope that Dr Smith's editorial marks the beginning of a focused effort on the part of the JAOA to provide the osteopathic medical profession with the skill sets it needs to survive the next 20 to 30 years of US economic uncertainty. 
Smith DA. Understanding insurance: will a public option or co-op get us where we want [editorial]? J Am Osteopath Assoc. 2010;100(4):226-228. Accessed June 23, 2010.
Fredricks TR. Protecting patients and maintaining professional sovereignty in the midst of intrusive government change [letter]. J Am Osteopath Assoc. 2009;109(12):622-623,651. Accessed June 23, 2010.
Alarkon W. CBO: Huge deficits to average $1 trillion per year over the next decade. The Hill. March 5, 2010. Accessed June 23, 2010.
Dickson DM. CBO report: debt will rise to 90% of GDP. The Washington Times. March 26, 2010. Accessed June 23, 2010.
CBO: Obamacare unlikely to reduce spending on health care; July 2, 2010. The Heritage Foundation's Fix Health Care Policy Web site. Accessed July 6, 2010.