As we consider the eventual surviving health care system in our country one must consider the eventual single payer system, which I already included in one of my earlier blogs. This is what other countries have but have created all sort of problems that I’m not sure the people in the U.S. will tolerate. The other consideration is then how is the eventual single payer health care system paid for? In other countries the health care systems are paid for with higher taxes such as the huge income taxes such as the Scandinavian 64% income taxes or the Value Added Tax (VAT), which in England will be raised this year from17% to 27%. Actually, I believe, that the use of the VAT may be a consideration to use in our country because this is a consumer tax and if you want to limit your tax, just consume less. But more important, I want to consider the problems with single payer systems. Just look at the “best” example of a single payer health care system in the U.S.- the Veterans Association health care systems. What are the problems coming to air with the whistle blowing in this recent political hot topic/scam? We are being told that there are significant waiting times and fraudulent scheduling, etc. are hiding the waiting times. We are finding out that some of the reasons are the lack of primary care physicians and other health care workers. Also, the quality of the health care delivery system and the health care workers is abysmal. This single payer health care delivery system is a strong union, which the former head of the VA system found to hinder him, the inability to fire the incompetent members of the system. The doctors and nurses are comfortable with their incompetence and seemingly there is no incentive to improve the health care system. This is not a new development, but because of the larger numbers of Vietnam, Iraq, and Afghanistan vets and due to the varied diseases and deformities resulting in modern warfare the burden has increased. The Times cites Dr. Phyllis Hollenbeck, a primary care doctor who took a VA post in Jackson, Miss. in 2008. She found “13 hour work days fueled by large patient loads that kept growing as colleagues quit and were not replaced.” Dr. Hollenbeck filed a complaint and handed in her notice to resign. As competition for primary care doctors increases, hospitals and health care systems will have to be competitive in their hiring practices in order to attract and retain physicians. So, the new laws proposed have either been seeking additional funding for the VA health care system or the deflection of the vets waiting for their VA docs into the private health care system. The problem with these suggestions is that the funding will do nothing to help the quality of the system unless we can fire the incompetents and find some way to induce quality doctors and nurses into the VA system. Consider that the students considering the field of health care as potential physicians have and will continue to decrease seeking medical careers, creating the same difficulties in the private health care system as in the VA system, especially with the influx of the 31 million of “new” enrollees into the health care delivery system. Now with this proposed bill there will be an even larger increase in the number of potential patients with the addition of the younger Iraq and Afghanistan veterans joining the aging veterans who served in Vietnam and Korea. The VA system has seen primary care appointments jump up 50% in three years. We also should look at the quality of physicians, as the future of the health care system develops. The Dean of Harvard Medical School said it best in his Letter to the Editor in the Wall Street Journal years ago when he pointed out that the students that were being accepted by his school, that five years ago they wouldn’t have considered the incoming students in the waiting list for admission at Harvard Medical School. Students are seeing that there is no Return on their Investment in pursuing a medical profession. Therefore, look to the future with a lack of sufficient physician’s of which a majority may not be the quality or intelligence that we all consider a part and parcel of the American the health care of the past and hopefully the future. Consider the potential problems of the Affordable Care Act using exchanges, which limit the number of physicians and reduce the reimbursement rates, that is what they pay the physicians, to the same as Medicaid- about 10-20 cents on the dollar. How do the graduating medical students pay back their loans? Do we forgive their loans? Where does the funding come from then? We need solutions to these questions in order to create a sustainable health care system.