I attended a video conference today on heath care reform put on by AMSA and the AMA reps in my class. We talked with a senator's aide about the upcoming bills in the Senate and how they may or may not affect us as soon-to-be doctors. We talked about medicare reform, the public option and mandating insurance for all American Citizens. I realized during the talk that part of the problem with heath care today is that it is a business. We want to put the "incentives" in the right spot so more people choose family practice or general surgery in small towns where more people have medicare and doctors get less compensation, so hospitals will cut excess costs and 'medicare fraud', so insurance companies can still make money while paying for our health problems, but still prevent me from having to pay for your medicine. We want to cut costs without sacrificing service, we want to extend care without institutionalizing and assembly-lining it. We want it personal and cost effective.

There are too many conflicting needs in the system. We need to realize that we can't do everything. For the health care system to 1) be more cost effective and 2)less susceptible to litigation requiring "CYA" medicine while 3) keeping medicine personal is impossible. To be more financially solvent requires a movement towards the 'mammograms only starting at 50' type of thought. Preventative care for everyone is not necessarily cheaper than paying for a few people's major problems. We just have to be comfortable with more people dying than absolutely have to if we would have checked everyone starting at 25. In order for the system to be less litigious, we would need universalizable regiments of care, requiring large amounts of paperwork and consulting to create and even more if you think your patient is different than the 'average' person the regiments are designed to be helpful for. If money is the bottom line there is no solution possible.