I listened to President Obama’s health care speech to Congress with interest and a little hope. There were some things I was hoping he’d say. He talked a lot about insurance and costs. Requiring coverage for preexisting conditions, something about employers having to provide health care, etc. Where I perked up was when he tipped his hat to the Republican side of the room and said that considering malpractice reform wasn’t the cure-all but should be investigated.

In other words, I didn’t hear what I wanted to hear. In the days after the speech I’ve been stewing on not so much how Obama and the Congress are wrong but what they should be doing right. The approach that keeps coming to mind is “follow the money.” If health care is expensive that means that money is moving somewhere. Someone (or someones) is getting rich on this. So if you want to fix health care, find out where the money is going and start there.

I could be wrong, but as I understand it health insurers aren’t going out of business but they’re not making record profits either. Employers certainly aren’t making money off employee benefits so lets not start with these two. Sure, they may need to be fixed but that isn’t where the money is. Doctors make a lot of money, but not all of them. They are highly educated and skilled and so I think they deserve to be better paid. There is some money there but I don’t think doctors are the end of the trail. A friend of our family is a doctor and he told me that he knows a neruo-surgeon who pays $200,000 a year in medical malpractice insurance. So if this guy has to factor that much overhead into his rates, maybe we’re getting close to what needs to be fixed!

From what I can see, the ones who are making big bucks in the health care arena are big drug companies and lawyers. Again, I’m not an expert but merely an observer. I could be way off base but what bugs me is that I don’t hear anyone investigating where all this money goes. If the government really feels like they need to fix the health care system in America, it seems to me they should start with these two big money makers.  That means that President Obama’s halfhearted, lukewarm “maybe we’ll eventually begin to take a look” at legal reform needs to get firmed up. That’s a tall order. It doesn’t fit in a nice little box that can be dealt with relatively quickly. It touches on a wide range of legal issues and it faces some very stiff resistance. Many of our lawmakers are lawyers and many lawyers are lobbyists and as I’ve noted, there is a lot of money with the lawyers.

And who is ready to tangle with big pharma? Look at all the good their drugs have done and aren’t they allowed to make some money off the investments they’ve made bringing this life-saving medicines to people? See how that can be framed? Tangling with the big pharmaceutical companies could turn into a political “third rail” pretty quickly.

So I don’t think out politicians have the courage to actually deal with what may well be the problem with health care. Instead we’re going to focus on the insurance companies and employers who pay the health insurance companies. And the insurance companies pay the doctors and hospitals who pay the pharmaceutical companies and they all pay the lawyers.