By Bob Thomas

Insurance companies are no longer viable in health care for many reasons, some beyond their control. There should be no profit in health care except where there is genuine competition. Reluctantly, I think it's time for government to become our only medical insurer, but not the service provider.

I must remind Vince that while it's terrible to pay one-third of one's retirement income for health insurance, it's no free ride in Europe either. While recently visiting Helsinki, Oslo , Stockholm, Berlin and London, I talked about medical care with several of their citizens, all of whom love what they perceive to be their "free" health system.

But considering their tax rates, we're still far better off than they are, if we can get as good a coverage as they have for what we can afford to pay. This can, over time, be done with some reforms. Our coverage must include everybody, and be consistent with the quality of our medical services, which are the best in the world.

I think the Medicare model of insurance, except for the abominable paperwork which adds thousands of people to government and doctors' payrolls severely increasing medical costs, could be made to work for all of us.

But there must be a monetary deductible that is costly enough to stop the fakers with hangnails who want the day off from work, with pay, to see a doctor. And it must also stop some of our senior citizens who are lonely and want somebody to talk to, so they go to the doctor.

These loopholes are killing the British system. Furthermore, there should be no government insurance for elective or cosmetic surgeries of any kind, except in cases of accident or cancer reconstruction. Let those who want boob enhancements pay for their own.

Moreover, a single medical accreditation group shouldn't be able to control the number of medical school admissions each year. That should be strictly up to the schools themselves. We need lots more doctors. We need competition.

And along that line, I think it should be illegal for professional organizations to even suggest what its member practitioners' fees should be. It's a disguised form of price fixing and anti-trust. And that includes the bar associations and the trial lawyers as well.

Doctors and lawyers are not only influenced by these "suggested" fees, they're coerced. Woe to those who dare undercut them --peer ostracism at the very least, not to mention the withholding of hospital privileges and the like.

We are a society at the mercy of special interests. If we truly deserve the opportunities our private enterprise system can provide then all professionals should stand on their own two feet without special interest protection.

Now, we can't talk about medical costs and ever increasing insurance premiums for fewer benefits without talking about tort reform -- capping damages for medical malpractice.

Some people, and I hope Vince isn't one of them, think of huge monetary damages routinely awarded by uninformed juries to plaintiffs as being a justified way of redistributing wealth -- insurance company wealth.

There is no concern for the fact that all such awards affect the rest of us. Every insurance premium we citizens now pay has a lawsuit monetary reserve built into it.

Malpractice damages must be limited to actual costs and income loss, and perhaps some pain and suffering. Punitive damages must be eliminated. Doctors don't deliberately hurt patients. Even though highly trained, they're not perfect. And they have private lives in which they, too, can be negatively affected emotionally at the wrong time.

Without tort reform there can be no reduction in doctors' fees. And even if our government does become our medical insurer, that won't help doctors afford malpractice insurance. I applaud that group of orthopedic surgeons last week in Las Vegas who walked off their jobs at the UNLV trauma center until malpractice damages are capped. Every doctor in the country should do likewise. Even mine.

Probably the best thing that can be said in favor of socialized medicine is that trial lawyers would be out in the cold. Government couldn't allow its own doctors to be sued for enough money to interest lawyers. But first, my proposed reforms should be tried.

But how? The vast majority of legislators, both federal and state, are lawyers. They've always protected their own interests first. Neither my reforms nor Vince's socialized medicine is in the best interests of trial lawyers. The only way I can see citizens reforming medical insurance is if we stop electing lawyers as legislators, or by the other extreme of electing only socialist lawyers ... and to hell with that!

Bob Thomas is a Carson City businessman, local curmudgeon and former member of the Carson City School Board and Nevada State Assembly.