Dude sadly trades his seahorse for real thing

For my two preteen boys, everyone is a dude, and most of life is awesome. I never really thought of myself as a dude, but life is all about changes.

My wife grew up with horses. She loves them and anything with four legs. Our boys have been taking riding lessons, and I'm being encouraged to fence off a field and build a stable. My lack of equine enthusiasm is a problem.

Every summer we go to the beach as often as possible, but never often enough for me. This summer "we" decided not to go to the beach at all. We planned an educational trip for dad. We went to a dude ranch, Twin Peaks Ranch in Salmon, ID.

As my boys said hourly, it was awesome. The food, accommodations, people, scenery, and wide range of activities were all amazing. And I got to be good buddies with Rudy, my horse. By the last day, Rudy and I were feeling pretty cocky herding longhorn cattle. Billy Crystal has nothing on me.

In addition to Rudy, I made some friends with two legs. Deana and I spent a great deal of time with Peter and Sylvie, from Cheltenham, U.K. Our kids are about the same age, and they are both physicians. Among other things, we spent a lot of time discussing the relative merits of various healthcare systems.

You're thinking, "What kind of idiot discusses healthcare systems on vacation?" But over a nice glass of chardonnay, looking at some of the most beautiful, unspoiled mountains in the West, I could enjoy a conversation about mud.

When I entered medicine in this country, it was a profession. Medical priorities mandated most of the decision making. Now it is a business, and corporate values (oxymoron?) dictate many major decisions.

While I understand the evolution and motivation for this change, I believe that our system has evolved to a point where too many people who provide not one iota of healthcare are receiving far too many healthcare dollars. I'm just not sure how to fix this problem. I really hate people who complain about the status quo but offer no reasonable alternative.

Talking to Peter and Sylvie about healthcare in Europe, I realized no one has the ideal system. While I have yet to come up with the perfect redesign of U.S. healthcare, however, I do have some specific suggestions.

Corporate profits, percentage bonuses, entrepreneurial spirit, and direct-to-consumer marketing do not benefit medicine or patients. All companies that receive any income from healthcare dollars need caps on salaries and profit margins. Not unreasonable caps, but the only way Blue Cross executives can compensate themselves $20 million a year is by denying someone care. I find it ridiculous that the guy on TV selling scooters to Medicare patients is swallowing millions of healthcare dollars. Ditto the guy making Viagra ads.

Universal coverage is not an attainable goal. Universal access to a high level of care is. The government builds roads. It does not give everyone a Cadillac or Maserati. We need to make some tough decisions about what we as a country can afford to provide for everyone, and then do it. Leaving the burden of the "uninsured" on providers is not acceptable.

Medical decisions and outcomes need to be completely divorced from the legal system. Bad outcomes are inevitable and very hard on patients and their families. Regardless of fault, help should be available for all. Bad doctors and hospitals need to be dealt with separately. We all know how much waste defensive medicine generates, because we often benefit from it.

Finally, people in the U.S. need to realize that death is part of life. I know that near the end, I won't want to give up. That is why it is so important for reasonable, compassionate leaders to set some end of life guidelines and restrictions.

Whoever wins in November, I hope he is willing to make some tough decisions. A lot of European dudes are watching to see how we tackle this awesome problem.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at

btipler@medicaltees.com

.