Having been closely associated with the health care industry, albeit many years ago, I feel that I can speak to the Business of Medicine. The majority of our difficulties with the current health care system stem from a central point of failure: the extremely high cost of medical education. Put in the simplest terms a fledgling physician, encumbered with many hundreds of thousands (perhaps millions) of dollars of debt, must earn hundreds of thousands of dollars just to break even. This is the beginning of the slippery slope.For the sake of discussion lets say that Josephine-the-Doctor hangs her shingle and begins her practice. On the very first day, in addition to repaying her student loans, Dr. Jo has to have resourced an office (exam tables and a few bandaids), employed one or two Nurses and/or Physician Assistants, and a Business Manager (who does the HUGE paper choked billing procedure). This Business Manager, being an adept Accountant, will quickly determine how many patients Dr. Jo will have to see, at "regular rates" in order to just keep the doors open (and the pay checks flowing). This explains why a patient gets only 10-15 minutes with a Physician at any give appointment. In addition to the base costs of opening her practice Dr. Jo and all of her staff have to carry Insurance. We can be well assured that this is not PL/PD with a 500.00 dollar deductible. While this is a necessary business expense it is the foundation for a social or cultural problem with our health care system. We will hear more as Dr. Jo's story unfolds. Being the good Doctor Josephine's popularity increases and so does her patient load. In our simple story the Business Manager's answer is to simply multiply everything by 2 and divide Doctor's time with each patient in half. Kindly Dr. Jo gets to see twice as many patients but also incurs twice the cost. This goes along fine until Dr. Jo puts her foot down and says she has to have a life outside her practice. The Business Manager ponders the situation for a fraction of a second and says, "Ok, we'll be more selective about who we accept as patients and we will charge higher fees. That way you will make the same amount of money and have more time for your family." Dr. Jo immediately notices that she is seeing fewer Medicaid/Medicare patients. Dr. Jo's newest patient, Bill, is an ideal candidate according to the Business Manager. Bill's Health Insurance is first rate. The Business Manager says, "We must see that Bill gets the best Health Care possible." It turns out that this is office code for 'perform every service allowable under Bill's Health Plan'. While Dr. Jo only gets to see Bill for the allotted 12.5 minutes her staff, at the direction of the Business Manager, makes sure that Bill is scheduled for all of the "proper" diagnostic exams and evaluations, on a regular basis. Bill doesn't realize the cost of his health care because his "Insurance" dutifully pays to the plans limits and schedules. Only the Business Manager knows that real costs. Then one day, out of the blue, Bill drops dead. The Coroner determines that Bill died of a rare but treatable condition. Upon hearing this Mrs. Bill calls her neighbor Larry-the-Lawyer. Tearfully she poses the question, "If Bill had such a great health care plan and was scheduled for all of those exams and evaluations on a regular basis then how come Dr. Jo missed this treatable condition?" Larry-the-Lawyer consoles the widow Mrs. Bill and assures her that he will look into the matter. This is where Dr. Jo's very expensive insurance re-enters our little story. Dr. Josephine is an upright, caring, feeling, conscientious practitioner of the Medical Arts. Unfortunately she and many other Doctors are subject to the forces of an economy which cares more about budgets and costs than it does about care.