I’ve been watching the Sunday morning talk shows, and naturally health care reform is the favorite topic. Ideas swirling today:

Doctor Shortage

On Andersen Cooper, they got around to the shortage of primary care physicians. Sanjay Gupta noted that even in Massachusetts, where something like 97% of the people now have health care coverage, there is still a glut of people in hospital emergency rooms because they can’t find primary care elsewhere. I’ve mentioned the physician shortage myself; I still don’t understand why it isn’t front and center in all the discussions of health care reform.

It occurred to me that the problem really isn’t providing health care coverage to everyone; it’s providing the actual health care. That means having the necessary numbers of doctors and having them distributed in such a way that everybody can get to one. I doubt that can be accomplished and it certainly isn’t being addressed right now. But it’s a fact, and the mere issuance of health care coverage isn’t going to make any difference in our health care delivery system.

Defensive Medicine

Defensive medicine was mentioned as one of the factors in rapidly rising health care costs. Some panelists immediately dismissed the idea as not creditable. The truth is probably somewhere between the extremes. Some doctors, in some cases, probably do order more tests just to make sure they have covered themselves if they get sued. But where malpractice suits really increase health care costs is in the skyrocketing malpractice insurance rates doctors have to pay; those costs get passed on to consumers, either as higher medical bills or as reduced access when doctors close their practices. Somehow, though, the health care reform talk in Washington never seems to include tort reform — maybe because so many lawmakers are lawyers.

Funding

Obama keeps talking about how much of his program will be paid for with cost savings and efficiencies. That’s wonderful news. But assuming those opportunities for savings and efficiencies exist, why haven’t they already been implemented? Why, in these lean economic times, haven’t belts already been tightened and budgets already slashed? Show me the money, Mr. President. Tell me exactly where all those untapped savings and efficiencies are hiding. Let’s implement every one of them right now, today. Then, and only then, if they actually generate as much money as you say they will, you can go ahead and spend that money on health care reform. That’s how the rest of us do it. We buy things after, not before, we’re sure we have enough money.

One savings mentioned was booting all the illegal aliens out of the country. Reports are mixed on how many of them are bumming free medical care in our emergency rooms, but the message is clear. Strict enforcement of our immigration laws, already way overdue, would take some of the pressure off our health care system. And, by the way, it’s up to law enforcement to handle this. Doctors and hospitals can’t be expected to ascertain the citizenship status of their patients before treating them.

Hard Times and Bad Timing

The housing market crash, the banking bailouts, the auto industry woes — all began on George Bush’s watch, if not before. Enter President Obama, with his glorious plans for health care reform. But he inherited a nation on the brink of a financial meltdown, a crisis that had to be dealt with quickly. Not his fault, but his to deal with. With money. More money than most of us can comprehend. But what we do comprehend is that with all that money spent to save the nation from a depression (we hope), we really don’t want to spend additional incomprehensible amounts for health care reform. Not right now. Not until we regain our financial stability. Not until we feel less vulnerable.

Maybe Obama should recognize that events beyond his control have made this a particularly bad time to push health care reform. Maybe he should just fall back, regroup, and try again in 2011.

I once had a sign in my office:

If you don’t have time to do it right the first time,
when will you have time to fix it?

Health care reform. Let’s do it right the first time.