(Posted on behalf of Bill Pearlman. -- Stace)

I don't have answers for the health care reform crisis. I can only speak to things that I see as problems. People are afraid that if the government steps in with a public option that the government will be telling docs how to practice medicine. Right now the insurance companies are doing that. They dictate what drugs we can prescribe and continually throw roadblocks in our path, necessitating 20-30 minute phone wait times to approve what they almost always approve anyway. Seniors are afraid that if the government gets involved they will lose their Medicare. Who do they think runs Medicare?

Primary care is a key to any health care reform. Currently the numbers of medical school graduates entering primary care specialties like Family Practice, Pediatrics, General Internal Medicine (without subspecialty), and Ob-Gyn is a very small percentage of total graduates. Who wants to enter a specialty where it takes 15 years to pay off your student loans? One way to increase the numbers of graduates going into Primary Care and to increase the quality of medical students would be to make medical education free, but expect several years of service in an underserved area as part of repayment. The idea of giving back to the community needs to be part of the social contract in medicine.

Helping to correct the disparity in reimbursement between those specialties which demand patient time and thought and communication and those specialties which depend on billing for procedures would help to attract providers to Primary Care. This would help to rein in some of the costs. Another way of decreasing costs would be to control senseless suits. If tort reform were included in the package, the 30% additional costs related to practicing defensive medicine would be removed. Increasing availability of primary care would also decrease ER visits. An ER visit for a cold or flu generates a cost increase of 300-500% for the system. And it usually means a wait of up to 7 hours in the ER.

These are just a few thoughts off the top of my head.

--Alan Firestone, M.D.
Family Practice
El Pueblo Health Services
Bernalillo, NM