by Manan Trivedi
PA2010.com, 9/29/09

I went to medical school to pursue a profession that would allow me to serve my community, be intellectually stimulating and provide for my family. I have found all these to be true in my medical practice. What I did not recognize at the time is how honored I would feel to be given the opportunity to treat patients.

As a doctor, you are inserted into people’s lives at moments when they are the most vulnerable and the most in need. It is truly a privilege to play such a critical role in society. I believe that most physicians still feel this way and that is why they continue to practice—not simply for the financial compensation. The pure practice of medicine is still a fairly decent and noble endeavor.

However, the greater health care system lacks this worthy underpinning.

Right now health care is driven by money. The bottom line coerces all other decisions and the system, as a whole, is quite inequitable. Insurance companies have far too much control over the entire clinical process and many patients with and without coverage are excluded or marginalized. Meanwhile, costs continue to rise so rapidly that they are consuming the budgets of families, businesses and the government.

Yet still our population is less healthy than most other developed countries that spend far less per person on health care. There are few people that would argue this is a sustainable system—and there is no doubt in my mind that health care reform is needed, and needed now.

I believe there are a number of different ways to remedy the health care system. The actual mechanisms we use, in my opinion, matter less than the achievement of certain overriding principles. Health care reform must meet the following goals:

1. Cover everyone. We can not get anywhere if we continue to have a significant portion of our population without regular access to quality, affordable health care.

2. Address rising costs in a real and meaningful fashion.

3. Reign in the insurance companies so clinical decisions are made by doctors and their patients.

4. Eliminate discrimination based on pre-existing conditions..

5. Take action now to improve the overall quality and efficiency of care provided.

The various proposals in Congress cover most of these concerns. These bills are not perfect, but they are strong steps in the right direction. No matter what happens with the current legislation, it is clear that health care and health care reform will continue to be a major focus for America. However, if these bills get watered down or amended significantly, they will not amount to much of anything and could create more problems than solutions.

I currently have seen no other alternative to achieve real cost control and truly provide significant competition to the insurance companies than a strong public option modeled after Medicare—where a public health insurance option allows patients to have their choice of private health care providers. That is the only mechanism proposed that offers a serious alternative to private insurance, and I would not support a bill without one.

I believe that allowing the Medicare Payment Advisory Committee to be a more independent and stronger body will go a long way in making the system more efficient and reign in excess costs. Creating programs that focus on everyday health and fitness will help stem the rising tide of chronic diseases such as obesity and diabetes. Investing in comparative effectiveness research will allow us to get a better handle on what really works and doesn’t work in medicine. And, providing more incentives for doctors to enter the primary care field and retaining those who already exist will improve the quality of care and place a new emphasis on preventive care.

Reform legislation with these components will also have significant positive impacts on our economy. American companies will be more competitive on the global marketplace as health care costs level off and individuals will be more apt to pursue entrepreneurial ventures without fear of losing health benefits. If enough is done to address wellness and chronic conditions, it is likely that productivity will also increase from a healthier workforce.

But at the end of the day, this issue is a measure of our character as a nation. Beyond all the statistics and policy arguments, the most compelling reason we must have health care reform goes back to that critical and vulnerable moment with the patient.

When someone comes to me and asks for help, I, as a physician, find it unconscionable to turn my back on them in their greatest time of need. We, as a country, should too.

The writer, a primary care physician in Reading, is a Democratic candidate in the 6th Congressional District.