Health care reform seem to be in “critical condition” and with Senator Joe Lieberman and others saying it should be abandoned for now, let’s look at a few policies that might have made sense.

Tort (malpractice law suit) reform, public university medical schools and reprogramming student financial aid are three further solutions to the health care cost and universal coverage crisis. None of these are a central part of the Obama administration health-care reform proposal.

The “Schmidt Paradigm” is “health care reform is a function of the accelerated supply of publicly trained healthcare providers through drastic retargeting of student financial aid as a function of the demand for health services, correlated with the containment of frivolous legal costs and unnecessary procedures.”

First lets look at tort reform, which is widely opposed by trial lawyers and by many who say it’s a phony issue. A very well known and respected physician with whom I spoke recently lamented that doctors such as he have not been included in the debate over health care reform. Instead it’s politicians, pharmaceutical companies, insurance giants and advocacy groups for the poor and under covered.

He averred that much of the cost overrun problem in health care is caused by the defensive behavior of doctors (“defensive medicine”) all up and down the healthcare provider chain against lawsuits. The excessive referral by general practitioners to specialists he contends is largely caused by the fact that a GP is not a specialist on any of the health problems he discovers in patients.

If she or he does not refer them to a specialist and gets sued, the patient will win because a judge or jury will buy the argument that “she’s not a heart (liver, cancer, allergy, hematology, bone, skin, toenail or whatever) specialist and should have referred the patient.”

The same is true of the extensive and often excessive tests that are run even when a doctor is very sure of a correct diagnosis. Again, the purpose is not good health care but mostly a protective move to inoculate against these lawsuits. Surveys have proven this and 93 percent of high-risk specialists in Pennsylvania and 83 percent of Massachusetts physicians admitted to practicing defensive medicine.

One frightening further aspect of all this is that electronic record keeping of medical information on patients will NOT save any money and in fact is expected to greatly accelerate and escalate health care costs. Why? Because without tort reform and protection from frivolous lawsuits doctors will be given electronically and automatically all the optional test that they could and maybe should run on each patient.

My doctor friend also pointed out that already in many places in the US there are no obstetricians because anything that may go wrong in a birth normally results in a lawsuit whether it was the doctor or hospitals fault or not. Therefore insurance is either prohibitive or non-existent.

He also pointed out that real cases of malpractice (which unfortunately is common) should be handled appropriately with compensation to the patient and some for of punishment for the offending health care providers.

Australia and some other countries handle this with an independent panel of experts not lawyers, courts and juries. These experts assess each case, dismiss the frivolous or non-relevant cases, and then award compensation and mete out punitive measures as necessary.

Second, lets examine the role of public university medical schools. My UPS delivery guy and I discussed health reform briefly in my driveway. He suggested that public universities which use public funds should require medical students to do much more community service in their first ten years of practice.

He felt that the public investment in a person’s education and career required some sort of reciprocity like that and was fair and just. It would also increase the number of doctors in under served areas.

He was not talking about small experimental programs but felt that “public” universities funded by “public taxpayer” dollars demanded this type of policy. My UPS delivery guy talks to thousands of people and is just like the taxi driver or the barber. He represents some very solid common sense thinking on issues and can’t be ignored.

Third, I’d like to take a peek at reprogramming college student financial aid. I tried to make a doctors appointment recently and you’ve no doubt had the same experience. You have to wait more and more weeks before he or she can see you.

Providing the uninsured 45 million Americans with health care is a necessary move but imagine what THAT will do to the already bursting at the seams health care system. The New York Times reported that, “Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.”

In fact, the Association of American Medical Colleges suggested that we need a 30 percent increase in medical school enrollment. This could produce 5,000 additional doctors each year.

However, the low pay and very high risk of malpractice suits for primary care doctors (those who see someone first) means that most medical students want to become specialists and not the direly needed primary care physicians. The same problem affects nurses and other healthcare providers. The big bucks are in the high-end specialties not in the vitally necessary preventive healthcare occupations.

“Under any set of plausible assumptions, an immense shortage of physicians is impending,” a story in www.medpagetoday.com said. It goes on to say that “the shortage is expected to exceed 124,000 physicians by 2025, and it will be most acute in primary care.”

Congress and the Obama administration are wringing their hands on how difficult all this is but in fact the natural and necessary solution is to retarget student loan and scholarship programs to the health provider fields. We honestly do not need more students in college and universities graduating with degrees in certain subjects.

“Medieval Scottish poetry,” “queer studies,” “the history of the chaco war,” “black studies,” “religious studies,” “political science,” “sociology,” “garden landscaping,” “marketing” and “banking and derivatives.” I am not aware that there has been a headline recently that “An immense shortage of journalists threatens the security of the United States!”

If students really want degrees in these areas, they should of course be free to pursue them and pay for their education. State and federal student loans and grants, one could argue, must be targeted to those areas critical to our state and nation and it is relatively easy to see that all aspects of health care qualify as critical.

The problem is that politicians and bureaucrats are slow to retarget anything and so it will take years if it is ever done to juice up the financial incentives to study in any of the medical professions.

All three of these reforms would have sailed through Congress (the trial lawyers would have to be corralled), public opinion would be 100% behind these changes, and we would be on our way to some lowered healthcare costs and some additional coverage for more Americans.

©20090Steffen Schmidt, Syndicated and posted here with permission from insiderIowa.com

— Steffen Schmidt is a University Professor of political science at Iowa State University and lead author of the country’s most widely adopted introductory college textbook, “American Government and Politics Today” (17th Edition, Wadsworth Publishing). He provides weekly political analysis for Iowa Public Radio, and periodically in Spanish for CNN en Español. He is chief political and foreign correspondent for http://insideriowa.com/