Health care reform

Its the talk of the country. You would have to be banned to ice caves in Siberia to not have heard about it. I just spent the last few days studying for a health policy exam, had a few conversations with colleagues, and decided it might be time for me to chime in on my feelings about health care reform. Ben Iverson posted a question on his blog about what should be a higher priority for change in the country: education or health care. I ended up writing a novel in his comments and decided to just copy and paste that into my own blog post. Here it is:

Education reform all the way! Don't touch health care. LEAVE government OUT of it. Ok, that is what I'm supposed to say as a physician in training. Actually, I feel there is a great need for health care reform...we need more preventative services covered and creative ways to cover 50 million uninsured Americans. But after going through two years of medical school and spending a few months in the wards, I think we're missing the mark in some areas with the current proposals of health reform. First, where is malpractice reform? Can I tell you how many unnecessary tests are ordered, which raises costs, because of fear of a lawsuit? Here is a prime example that happened not to long ago to me: A young man comes into the family medicine clinic with chest pain localized to a specific spot. He has no risk factors of heart disease(no smoking, diabetes, high cholesterol, high blood pressure,etc) and no family history of heart disease. Heart attacks generally feel like pressure on the chest and a patient won't usually point to a specific spot but pain will be all over. He likely has inflammation of cartilage of his ribs. Do we send him home with a high dose ibuprofen or prednisone prescription to reduce the swelling and tell him he'll be fine? No, that would be too easy. Instead we have to additionally tell him to go to the ER(since we don't have all the fancy equipment at the clinic) when he has the chest pain next, to cover our fannies from a lawsuit in the 0.1% chance he is having heart problems. Anyone think the ER will be cheap for this man or his insurance after they get done with all the testing? Will politicians, most of whom are lawyers, touch malpractice? I don't think so. We'll see.
Second, where is medical education reform? What person in their right mind will want to train for 12- 15 years, plunge into a half a million dollars in debt, and earn 50,000 dollars? Any takers? Let me be clear that I didn't get into medicine for the money. And physicians salaries being reduced to $50,000 may or may not be a reality. But I see my mounting debt and hear all the talk about health reform and it makes me nervous of how long I'll have this lingering debt if reform happens in some areas and not others. Check out this article published by a group of independent physicians for congress that addresses what I think are the critical needs in health care reform.
www.physiciansfoundations.org/usr_doc/Physicians_And_Their_Practices.pdf
I don't like insurance companies at all and their billion dollar profit margins...but I feel like congress is rushing too fast and may put in a system that we all regret in the future because they didn't think it completely through.

Many of the older doctors are saying they will retire early if reform goes through. If that happens, we'll have an even higher physician shortage and it will leave us young docs with so much work to do, will we ever see our families?