There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).

Supporting health care reform is probably a little of both.

Even if any of the currently proposed health care reform plans pass, it will make little impact on our crumbling health care system. That said, you MUST support health care reform now.

Why?

1. The current system is worse then broken. You probably know about the over 40 million Americans that lack health care coverage, and the fact that we pay more than any other country for health care, but have poorer health than most other countries. However, non-health related facts may be even more important.

The most common reason for bankruptcy in the US is medical bills. In addition, our nation’s industries can not compete in a global market because of health care costs. GM spends more on health care for its employees then the metal in the cars they make. The health care system is not only broken, it is crippling our entire company.

2. If we don’t act now, reform may never happen. Congress goes into recess at the end of the month. By mid-April, our representatives will start to focus on the mid-term elections. Thus, it is likely that nothing substantial will get done this spring, summer and fall until after November, 2010. If this is the case, regardless of the outcomes of the upcoming elections, no politician will want to tackle health care any time soon.

3. We are so close. We have never before had health care bills that have been passed in both the House and Senate. This is historic. We can’t stop now, because we may never get this close again.

4. There are actually some good things that will happen if reform is passed. Even if we don’t cover all the uninsured, any bill that covers millions more has to be worthwhile. Both side also seen to agree on eliminating pre-existing conditions and closing the Medicare Part D donut hole will be a major help to many of our seniors.

But the current health care reform proposals aren’t perfect.  Here’s why.

1. Coverage is not enough. There are four major problems with our current health care system: lack of coverage (uninsured, underinsured, pre-existing conditions), escalating health care costs, a poor delivery system including a primary care shortage, and an unhealthy population.

The other issue, of course, is how to pay for any fixes. Current proposals pay lip service to all four, but really only address coverage. All are inter-related, so without addressing the others, your can’t fix the system. Massachusetts is a perfect example. After expanding coverage to all residents, the state found that there weren’t enough primary care doctors to see everyone. These newly insured patients ended up going to the ER, leading to dramatically increased costs for the state.

I believe we should have first addressed rising costs and our delivery system. Fixes include malpractice reform and restructuring our payment system which pays for tests and procedures over prevention and counselling.

2. You are probably not affected. If you are reading this, you are doing so a work (you have a job) or at home (you probably have a job if you can afford shelter with a computer and Internet connection). This means that you likely have health insurance that is provided by your employer, like most Americans between 21-65. Similarly, you are likely not happy about your escalating health insurance premiums and possibly frustrated by longer and longer waits for shorter and shorter appointments with your doctor.

However, you likely want to keep your doctor, are thankful you have coverage, and though you feel bad for the uninsured, you are more fearful of what substantial reform might mean for you. The good news is that whatever passes will likely not affect you. The bad news is that we will likely not get any real change until things get so bad that most Americans demand change.

3. Things are bound to get worse. Though our dysfunctional system and plans for reform may not affect you now, things will get worse. Without addressing costs, premiums will continue to go up and even more patients will lack the ability to afford health care coverage. Without addressing the bureaucracy of insurance paperwork and they pay disparity between specialists and primary care physicians, students will continue to go into non-primary care fields and current primary care doctors will retire. In addition, our nation is only getting older and fatter, and thus sicker and more expensive.

Bottom Line: Our health care system needs massive changes. This can’t be done quickly, so one piece of legislation will not fix it. It will take many years and many pieces of legislation just to start moving in the right direction. However, we have to start somewhere. Though the current proposals will not work, they are a first step. In addition, a millions of Americans will get coverage and we may get a few needed fixes. Yet, if we fail to take this first step, and don’t pass something soon, it may be a decade before health care reform is discussed again.

Matthew Mintz is an internal medicine physician and blogs at Dr. Mintz’ Blog.

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