Speak Out: What should be included in health care reform to make it workable?

One statistic says 5% of the population spends 50% of the funds. Why aren't we micromanaging that 5%?

We need to look at the 60% of Medicare spent in the last 6 months of life and determine quality of life issues and where are those funds being spent. We've fostered the medicine to keep people alive, but we haven't fostered the support structures to handle it.

David C. Allen, MD
Athens, GA

"Tort caps are one thing-within reason. I've seen cases where settlements were totally justified, but when you're in a vulnerable environment, there should be some protections.

Cuts need to be made across the board. My resident and I were talking about how the cost of basic goods, such as a guidewire, are ludicrous. Durable medical goods, pharmaceuticals-everybody has to bring down their costs. Some technology necessarily costs a lot because of the materials andthe engineering, but most is way overpriced. Certainly, profit is deserved, but I can't believe they have to charge that much for each item."

Nina S. Davis, MD
Portland, OR

"Washington is missing the point. We need efficiencies more than we need tax increases.

One, address the cost of technology. Why are two competing hospitals in Oklahoma City each about to spend $300 million on a proton-beam linear accelerator when there's no proof it's better than other forms of radiation? Why do we have more MRI machines in Colorado than they do in Canada?

Two, admit that care must be rationed. Should 99-year-old Medicare recipients get a heart transplant? When we have the political will to accept rationing, we can have an intelligent conversation about health care. Fifty percent of Medicare is spent on the last 6 months of a person's life. That's crazy.

Three is tort reform. Any doctor who says he doesn't practice defensive medicine is lying. We order $3,000 imaging studies based on a 1% chance of a malignancy. We don't use our best medical judgment. I'll bet money spent to avoid lawsuits adds one-third to our cost of medical care."

Jeffrey E. Fegan, MD
Glenwood Springs, CO

"There has to be a recognized standard of care and fee scales agreed upon by insurance agencies and providers. We provide better care than we did 20 years ago, but our fees keep dropping every year. We get better at diagnostics and treatment, but we aren't compensated for that.

Big pharmaceutical and technology companies' costs keep going up, and we need those advances; however, we also need to make a truer standard of what fees should be for physicians.

We need patient access to health care. Patients have a problem with access because they don't have insurance. Unless it's a dire emergency, hospitals won't let them in the door. We may need more regulation for insurance companies so patients can gain access to equitable health care."

Timothy R. Moreno, MD
Sonora, CA

Modern Medicine NETWORK

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President Obama has made reform a priority, but can Congress create a plan that works? A leading physician shares his thoughts at: http://www.urologytimes.com/crisis