“There’s a threat on the horizon. In terms of lives lost this threat will dwarf 9/11 and the war in Iraq combined. It’s a threat that could potentially result in millions of lives lost prematurely. When it becomes a crisis, your doctor won’t save you from it. He can’t, not without your help now. If you as an American don’t begin to help shape the future of health care delivery in our country, there won’t be anything left to deliver. The politicians put forth fatally flawed proposals that they know won’t work, but they’re committed to them for political rather than scientific reasons. The left has no more of a working plan than the right. The AMA has suggestions, but they’re constrained by what’s politically achievable. Finding the solution won’t be easy, and it won’t be ideal, but unless we as a country begin a discussion, we will surely see a collapse of our country’s health care system. It has, in fact, already started and as evidence there are forty-five million uninsured patients in America right now. Forty-five million Americans are currently unable to access preventive care, putting them at increased risk for costly health problems in the future...Forty-five million with nothing but the spirit of charity in the hearts of health care providers to save them, if something catastrophic happens.”

Let me let you in on one of the basic facts of life, and no, you don’t have to be a doctor to know this one, everybody wants more- more money, more fulfillment from their lives, more love. If you need proof, look in the self-improvement section of any bookstore, or just turn on your television during the day and flip through the channels.

Why do we need more? Well, we need more money so we can get more stuff. Our society and our economy are based on a simple principle…consume, consume, consume. I hate to admit it, but I’m no different from anybody else, I need the newest two terabyte MP3 player, my crummy eighty gig is way too small, it only holds a thousand or so CDs. Who can put up with that? Unfortunately, as much as I delude myself to believe it is, my need isn’t a real need, I don’t have time to download a hundred CDs, much less a thousand. I have about thirty-seven CDs on my player, and yet I believe I need a newer, more technically sophisticated model. With the rapidity of technological evolution in the modern world, this cycle of need and fulfillment is never ending, as soon as I buy the new “two-T”, within weeks of the purchase of this technical marvel, they’ll begin to advertise a newer model, one that comes with a cell phone in it, and as soon as I get that, there’ll be an even newer model with both a cell phone and a miniature computer in it, and so it goes ad infinitum.

In a lot of ways medicine is the same way, but instead of ego and vanity being the only driving forces, it may truly be that our lives are at stake. We want more and we want better, the heck with better, we want the best. Who doesn’t feel that they deserve the best health care? America is nothing, if not an egalitarian society, in this regard, everybody deserves the best health care, right? I don’t know. Let me pose a hypothetical question, what if there were a drug that was ninety-nine percent effective in preventing osteoporosis in post-menopausal women, and had no identifiable side effects, shouldn’t we give it to everyone that could benefit from it? Sure, that seems like a “no brainer”… but, what if it cost twenty thousand dollars a dose? Ok, well, that does seem a bit steep, but it really would make so many lives better, I guess we still should. The problem is, at that cost, for that many women, most of which will be sixty-five years old, or older, the cost of the drug will bankrupt Medicare in a single year. Now, should we make this wonder drug available to our Medicare beneficiaries? By the way, I hate the term beneficiaries, almost as much as I hate the term, health care provider. These are patients, sweet little grandmothers and mamas, wonderful women, and I am their doctor with this wonder drug that will make their lives so much better. No longer will they have to face the chronic back pain and the debility of nerve root compressions that are associated with the pathologic fractures of osteoporosis. Can I give it to them?

This isn’t a medical decision, medically, the answer is obvious. From a risk-benefit standpoint the drug is amazingly effective, so it’s all benefit with no risk. The only risk is to the solvency of the largest health care provider in the United States. So, this decision becomes not a medical decision but a social decision, a governmental decision, a legal decision, even a moral decision, and the consequences of the way a decision like this is made, and the nature of the system put in place to make such decisions, will reverberate through the years, to effect, not just ourselves, but what type of a system our children have to look forward to. Will the egalitarian system we take as given, grant access to all to every technical step forward, or equally restrict access by all. Will equal access become a quaint naiveté` and give way to a two-tiered, or multi-tiered system of health care delivery, with the latest and best going to those who can afford it, and whatever’s left going to those who can’t? We would never stand for that, as a country, would we? We already do. There are forty-five million Americans without health insurance, the uninsured are now a sub-class, they don’t have access to the same preventative care and routine checks that the insured enjoy. As a matter of fact, even if they can afford health care, they may be afraid to seek it. There’s the big punch-a-roo, if they get diagnosed with a pre-existing condition, they may never get access to health care they can afford.

Do you know which segment of the population is the fastest growing pool of the uninsured? Poor people, right? Perhaps, the unemployed? Nope, on either count. That distinction goes to working males over fifty, that make over seventy-five thousand dollars a year. That can’t be right. That’s what I thought, until it happened to me. When a misrouted bill went unpaid, my insurance was cancelled without notification until sixty days after the action. And once you find out your policy has been cancelled, if you’ve gone more than thirty days without a bridge policy, you have to jump through hoops and throw around a good deal of loot to get any type of coverage. After several rounds of denials, and a total inability to get a private policy to cover either myself or my wife (every company was happy to cover our perfectly healthy children, for the same price we had been paying as a family). Thankfully, I have a good income and the cost of establishing a group policy and hiring my wife wasn’t an undue hardship, but it cost twice what I had been paying. Most families can’t absorb this.

In my opinion, any, health care reform has to deal with both of the issues we’ve dealt with. Until there’s some type of controls on drug pricing and insurance reform that actually reforms the practices of private insurers, any health-care policy we undertake is a mere band-aid.