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Q: So what makes you an expert?

The joys of the internet are balanced with the negatives of the internet, including the ability to be anonymous (yay for dissenting opinions, boo for trolls). "So what makes you an expert?" was a question by someone who had pointed criticism of the P.S.Y.C.H. plan.

So let me be clear: I'm not an expert on "health care reform."

I was board certified to be a psychiatrist by some folks who thought I did well enough on a test and a mock 30-minute interview. I was licensed by the state of Texas by some folks who took my money and background checked me. I have patients because they trust that I've done the above two things and have training to help them.

I am a human being that is, I think, somewhat reasonable. I believe it's reasonable to work hard for your livelihood and use the fruits of your labor to pay for reasonable medical recommendations. When I designed the moving parts of P.S.Y.C.H., I thought, what would most people find reasonable?

Most Americans find some measure of personal accountability to be reasonable. They want a safety net but hate entitlement. They love choice and hate exploitation. They appreciate fairness. These are all reasonable expectations in a civilized society. Our current system is pointedly unreasonable and skewed in all the wrong ways. P.S.Y.C.H. provides a better balance.

But the plan as it stands is just the scaffolding. As a physician, I lack degrees in finance, marketing, economics, public policy, governmental affairs, accounting, business administration – which is why I welcome the plan being discussed in a broad public forum so that we can come up with the best arrangement on top of the scaffolding I've provided.

For example, I think the "board" of each state nonprofit company should have nine members, five of which are medical and four "non-medical." Is that the ideal number? Well, it sounds great to me because this is a "medical" company and a preponderance of the leadership should have a firm medical background. But if a board of five or 13 works better, I'm open to it.

My point is that it should be a board of directors that are elected and directly responsible to the constituency that has elected them. And this board should know firsthand the pitfalls of patient care.

Hopefully that clarifies things for the you-betta-have-a-complete-workable-plan-or-else-I-ain't-buyin'-it crew.

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