4 recommendations to improve the national health-care system

You and I enjoy the best health care in the world. We receive immediate medical attention for life-threatening conditions, have access to the most advanced disease-detecting technology, and use the latest life-saving medications. We save premature infants other countries don't even try to save. We place heart stents and avert heart attacks only hours after a patient arrives in the ER with crushing chest pain. We have antibiotics, vaccines, surgery, cancer drugs, arthritis medications and artificial joints that keep us living longer and better than ever before.

The cost of this excellent care is significant, for good reason. Every screening test, biopsy and treatment costs something. As we enthusiastically applaud each "medical breakthrough" because it means earlier detection and treatment for someone, we add to the overall cost of health care — we must now screen, scan and treat for the new disease. Ultimately, medical costs have outpaced how much we want to pay. If we restrict doctors from offering patients the latest and best, or we restrict patients' access, we can cut costs, as other countries do. But that means rationing care – one aspect of government-run, socialized medicine.

So how do we reduce the overall cost, yet retain the high quality and access? As a physician in the trenches, here are my solutions:

1. Require everyone to pay his or her fair share. Insurance allows those who pay into the fund to draw on the contributions of others when a catastrophe hits. However, some taking from the system have never paid into it – those who purposely don't buy insurance and those who have entered the country illegally. Under today's laws, no person can be denied care at an emergency room (with insurance or not, legal U.S. citizen or illegal) – so all are seen at the ER, and you and I pay. Genuine health care cost containment must include genuine immigration reform (perhaps requiring tamper proof identification cards for legal foreigners) and a mandate that each individual purchase at least emergency and catastrophic insurance coverage, so we aren't left to pay for their hospitalizations. This works for auto insurance, why not health care?