We appear to have “bent the curve” in health care spending last year; national health spending grew at a historically unprecedented low of  3.9%. That’s including all national health expenditures — private insurance, Medicare and Medicaid, and out-of-pocket expenses.

You would think this was a good thing, right?

But according to Deloitte’s new survey, not necessarily:

• In the United States, three in four (75 percent) consumers say the recent economic slowdown has impacted their health care spending.
• Forty-one percent are more cautious about spending, 20 percent have cut back on spending, and 13 percent say they have reduced their spending considerably.
• Sixty-three percent say their monthly health care spending limits their household’s ability to purchase other essentials, such as housing, groceries, fuel, and education.
• In an effort to save money, 36 percent of prescription medication users say they asked their doctor to prescribe a generic drug instead of a brand name drug.
• One in four (25 percent) U.S. consumers skipped seeing a doctor when sick or injured.

• Consumers believe that hospital costs (68%), lifestyle

choices (62%), and fraud (62%) are major drivers of

overall health care costs. Administrative costs (57%),

prescription drugs (54%), and defensive medicine

(51%) are also commonly cited.

• Over half (51%) of all consumers believe that 50% or

more of health care spending is wasted

• Of those believing that the system is wasteful,

49% feel that money is wasted because

individuals are not taking enough responsibility

for maintaining their own health.

• Consumers also blame redundant paperwork

(55%), defensive medicine (46%), lack of

adherence to evidence-based approaches (40%),

and extreme measures taken at the end of life to

extend life for a short period of time (35%)

What are the odds that I would find myself in a room with two other women who  also worked at Intel and were passionate about health care?  I thought maybe a million-to-one until I met Halle Tecco and Leslie Zeigler at Rock Health. They are truly star power.

It gets better from there. Rock Health is a new nonprofit incubator in the touristy Chinatown part of San Francisco.  But take the elevator past the imported knickknacks and large animal sculptures in the doorway and you will find an open, industrial workspace dedicated to software development to change health care. These women have the dream of disrupting the worst-run consumer industry in America with new mobile technologies that put power back in the hands of patients and providers.

In case you are wondering where the power lies now, it’s in the hands of the payers.

In most industries, the growth of information technology has shifted power to the customer. Or at least put it in the hands of the vendor who can target based on known customer preferences.

But healthcare has very little CRM, and no VRM. These software driven terms translated to health care would mean that the provider had adequate information about you to offer you intelligent treatment choices, and that you as the patient had the power to choose who and what gets treated and what you will pay. In healthcare, the patient has almost no choice of either treatment or cost.

Rock Health has eleven resident grantees (who have received nominal sums of $20,000) in its the first program, and twenty “member companies” who have not received money but can come to workshops and receive advice. They are focused everywhere from preventing hospital readmissions, to drawing conclusions from large data sets, to helping people find doctors who will give discounts.

But Rock Health isn’t trying to boil the ocean of our broken health care system. Instead, it is trying to work around the intransigence of the existing old guard to empower patients. It doesn’t touch the areas of data integration or flirt with privacy laws no one understands. Realizing that mobile devices can be used for prevention, monitoring, and better communication, it is trying to encourage startups that can succeed in selling into this difficult market because they are not selling to hospitals, but rather selling WITH hospitals.

What I loved most about Rock Health, and why I plan to stay involved with it, is the energy of the founders, one of whom was recently diagnosed with ulcerative colitis and got a crash course in health care systems mismanagement herself while still in her mid-20s. She has blogged a bit about her colonoscopy prep here.

There’s nothing like being a patient in our health care system to fire you up for change.

I’ve been trying to understand why as a nation, we are so divided about health care reform. You would think every American would be generous enough to think the guy next door deserved decent health care. You would also think we would be embarrassed to have our issues aired in front of all the other developed countries, like our neighbor Canada, who extend protection to their own citizens. (Never mind those socialists in Europe). I mean, the single SuperPower, the country I grew up in, is expected to set a standard for the rest of the world to follow. But in the past year, we have set a standard only for uncivil debate, distortions, lies, half-true talking points, and backroom deals.

Health care reform has ceased to be about health care or reform. Instead, it is now about money, like everything else in the country. That monolith I hear about on C-SPAN every day “the American people,” has taken a collective haircut in wealth over the past few years. No longer to we feel like the richest, most powerful nation in the world. In fact, we feel like China is eating our lunch, the planet is warming or cooling, the Islamic fascists are out to get us, and our children may not even be getting a good education. We feel poor.

No wonder we have retreated into our shells, a nation of turtles. Recent events have scared the pants off us.  Especially events involving money.

We’ve spent the past eighteen months desperately de-leveraging, denying ourselves things we used to take for granted, and trying to climb out of debt. We are in no frame of mind to authorize spending on a single extra family-sized pizza, much less on an “entitlement program” that might raise the deficit, a concept we never discussed in the passed.

How many of us even know the difference between the national debt and the deficit? There is one, you know.

The deficit is the difference between the money Government takes in, called receipts, and what the Government spends, called outlays, each year. Receipts include the money the Government takes in from income, excise and social insurance taxes as well as fees and other income. Outlays include all Federal spending including social security and Medicare benefits along with all other spending ranging from medical research to interest payments on the debt. When there is a deficit, Treasury must borrow the money needed for the government to pay its bills.

The national debt goes up and down, depending on what’s happening in the country. For the last couple of years, because of the downturn, tax receipts have gone down, so the deficits have gone up.  Those accumulated deficits make up the national debt.

When well-run businesses run into a downturn, what do they do?  They don’t just stop taking risk. Often they use the time to invest in the future. The next time the economy turns around, they are well-positioned to grab a leadership position. Not that there’s anything wrong with paying down debt, but  you can’t downsize your way to success. You have to raise revenues.  You have to sell. You have to grow.

If we keep our population healthy and educated, then when the turnaround comes, we can quickly pay off our debt, because the deficits from income tax receipts will go away. We can grow. That will raise revenues.

Not passing health care reform is the flip side of fighting wars on two or three different middle Easts fronts at a time. It’s what we do out of fear. It’s not what we do out of strategy, or leadership, or even our Christian underpinnings.

I spent most of the day watching the health care summit President Obama held at Blair House today. I’ve drawn only a few new conclusions.

1)The process needs an independent, trained facilitator.  The President isn’t one. He’s in favor of his own proposals; his party has a dog in the hunt. That reduces his credibility. It also made him talk too much; I bet he took up almost a third of the time after dividing it pretty evenly between the Democratic and Republican members of Congress. The Republicans will use that to flog him in some way.

2)On the other hand, President Obama is very smart. He’s up on the issues, and he wasn’t reading from notes or a TeleprompTer. He’s immersed in this stuff, and he has been studying all the angles. You don’t have to agree with him, but you should admire him for the seriousness with which he approaches the job. In his dreams, he wishes we were post-partisan, although in reality we are not.

3)The Republicans have some good ideas. Most of them have already been worked into the existing bill, but it is difficult for anyone to admit that.  They would rather keep on talking about “nuclear options” and “government takeover of health care.” There are many things we can all agree on.

4)Everyone forgets that the President was elected on a platform of change. When the Republicans say “the American people don’t want this bill,” do they know whether the American people want less reform? More reform? No reform?  Are they objecting to the process or the product? There’s a possibility that most Americans want greater reforms; and at the same time there’s a possibility that they don’t want change at all (people have a tough time adjusting to change). Fact is, things will change no matter what we do in Congress. Longer life spans, an aging population, an increasing national debt, and more advanced technology will see to that.

5)It was remarkably difficult to watch the Summit on TV. MSNBC was covering the Olympics, and CNN kept breaking in and cutting away. Even C-SPAN only covered the summit live on C-SPAN 3, which not everyone gets with her cable service. At several points I had to stream it, and the streams weren’t dependable either.

6)The Republicans keep saying “let’s go back to the beginning” and “the American people don’t want this bill.” What if we DID go back to the beginning, and produce a much stronger bill with a nanny-state?  I’d bet we would be surprised how many people would want that; there is still widespread support for a single payer system that would take these decisions off our hands. People are not as prepared to embrace freedom of either markets or lifestyles as we would like to think. Eric Fromm wrote Escape from Freedom in the 1940′s about how man attempts to escape freedom: through authoritarianism, destructiveness, and conformity.

7) Nobody mentioned health IT, remote patient monitoring, patient-centered medical homes, or reimbursement changes as ways to cut costs. Why not?  Because the discussion centered so much on who has insurance rather than outcomes or patient care. Yet these innovations will probably both reduce costs AND raise quality of care. Ah, but they don’t have support from doctors, pharma, or insurance companies, because they are less about the free market than about improving quality of life.

8)From what I could tell from my social media streams, only extremists followed the debate. You would think there was no one but #tcot and #p2 who cared.

Actually, everyone cares–but if your opinion is any combination of R and D, you can’t get heard. At least Congress was on its good behavior today; Twitter was not. Normal citizens seem to have covered their ears.

That’s really about all I learned.  It’s not a lot from seven hours of listening and watching.

A few years ago, my partners in AHITA.org ( a non-profit organized to help providers implement EHRs)  and I implemented an electronic health record in a physician practice. Along the way, we evaluated every major product and discussed with the physicians in the practice what they needed and how to examine their workflows to automate.  It was very effortful, took almost a year, and cost the physician practice about $50,000 in consulting fees.  At the end of the engagement, the AHITA partners decided in all good conscience that all the products sucked and wouldn’t help a small practice; we kind of drifted away from the idea of electronic health records. Our physician partner, who had written his own EHR, gave up in disgust because he couldn’t get anyone to buy it.

Now, Obama’s administration has given incentives that mandate EHRs. 2010 looks like it is going to be the year. And hopefully, many of the products have improved in their ease-of-use and financing programs during the past couple of years. There’s a lot of behavior change around implementing new technologies, and even practices that already own EHR technology need to learn to use it properly to qualify for the meaningful use incentives the government is offering. For most practices, this will mean an increased focus on workflows around ordering, e-prescribing, and clinical decision support and some attention to improving them, not just automating disfunction.

As far as I can discern from listening to the Allscripts webinar I just heard, many of the incentives revolve around seeing more Medicare and Medicaid patients.  All those physicians who were going to give up Medicare patients will be re-thinking that, because to qualify for the stimulus money they have to prove that 44% of their volume is Medicare, or 30% is Medicaid. And this is calculated by individual physician, not by practice.

For a physician, the Medicare part of the program starts this year. But this year you only have to prove that you used electronic records for 90 days during the year, and that at least 50% of your patient encounters have to be at a practice using a certified EHR. That goes up with every passing year.

Another interesting incentive: the physician’s payment will be based on multiplying his or her allowable charges  by 75%, so seeing a Medicare patient and using an EHR should make the patient (me) worth 75% more to the physician who sees me, especially if he delivers professional services, and doesn’t just send me for an MRI or to a lab. The incentive doesn’t count  fees for surgicenters or technical components of a doctor visit. This will be Medicare Part B services. (A physician aiming to collect $18k in 2011 has to submit allowable charges of $24k to Medicare and she will get paid $24k+$18k).

Physicians have to choose whether they want to participate in the Medicare part of the incentive program, or the Medicaid part. For a busy primary care practice, I bet Medicaid patients begin to look more attractive.

Now, away from the money and on to the part that benefits the patient:

Your doctor will now have to use five decision-support alerts in her software, and will have to give you electronic access to your records within 48 hours of your request. The incentives encourage the patient to become part of the conversation, and the doctor to communicate with the patient electronically. The government wants people to use personal health records, and for the physician to communicate with those PHRs, and that is going to happen FAST.

Here’s what the EHRs these physicians adopt will be required to do for the physician to get the subsidy:

• Electronically select, sort, retrieve, and output a list of patients and patients’ clinical information, based on user-defined demographic data, medication list, and specific conditions.
• Calculate and electronically display quality measure results as specified by CMS or states.
• Electronically submit calculated clinical quality measures
• Electronically generate a patient reminder list for preventive or follow-up care according to patient preferences based on demographic data, specific conditions, and/or medication list.
• Implement automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) according to specialty or clinical priorities that use demographic data, specific patient diagnoses, conditions, diagnostic test results and/or patient medication list.
• Automatically and electronically generate and indicate real-time, alerts and care suggestions based upon clinical decision support rules and evidence grade.
• Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user.
• Electronically record and display patient records and connect with other providers
• Patient information: electronic copy upon request in 48 hours80%
• Patient access to electronic information (i.e. lab results) within 96 hours of availability10%
• Clinical summary of each patients’ insurance eligibility, and submit insurance eligibility queries to public or private insurers

All the major products do this in one way or another. This doesn’t make them easier to deploy or train staff on, or use. Or make the change management any easier (that’s the part I do).

However, this sounds very promising for both the patient and the physician. And it’s not part of health care reform legislation, it was part of the stimulus, so we know it’s going to happen.

Makes me remember when electronic claims processing came into widespread use — which was not until Medicare mandated sending them electronically in order for physicians to get paid.  You’d be surprised how fast paper claims disappeared:-)

We knew it all along. One third of the dollars spent on health care are wasted, and 22% of that waste is outright Medicare fraud. I don’t know if you saw 60 Minutes last night, but there was an incredible segment on Medicare fraud that said it’s now bigger than drug cartels in Miami, because it’s so much easier. No one shoots you; you just have to rent an office, put a sign up, buy some lists of Medicare patients, and start producing invoices.

Medicare is legally bound to pay within 30 days (they reimbursed me for my mammorgram before I even had the results), so these businesses only need to stay in business about 60 days to cheat Medicare out of $20 million. They order prostethic limbs for patients (sometimes they order two arms and a leg on the same invoice) and charge it to a patient who receives an Explanation of Benefits he doesn’t understand. By the time he tells Medicare and they get an inspector out, the office has closed down, the people are gone, and Medicare’s the loser.

I was stunned watching that last night. And then I read this study today. Reported by veteran health and science reporter Maggie Fox, is says that a full one third of our health care expenditures are wasted, and details where and how.

Unsurprisingly, 6% of the waste is due to paper records and the failure of communications that results from health care’s lack of automation. And protection from malpractice, which means overuse of antibiotics and useless testing is another 37% of the waste.

But the most important realization is that these add up to BILLIONS of dollars a year, just as Obama said. We can pay for health care reform by reforming our spending habits.

Here are some more highlights, but go read the entire piece.
Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

I spent the day at Health 2.0 conference in the Bay Area. This is the third year of the conference, and it has grown from a fringe group of early adopters and application developers to a bona fide e-patient movement, probably spurred by the broken health care system.

Health plans already know that whatever versions of Obama’s reform plan are passed, they will be dealing more with consumers and less with employers in the future. They are are investing in the tools to do a more subtle form of medical management than they did in the ’80s, when the HMO movement became known for the dreaded “gatekeeper” concept of denying care. During the heyday of this concept, health care costs escalated about 25% over a decade.

However, consumers became so angry that in 1999, one of the largest payers, UnitedHealth Group, said it would do no more medical management. All other plans had to follow suit, and with no effective medical management, health plan costs exploded 60% between 2000 and 2007. 20% of all commercial plan enrollees have been priced out of coverage, and now health plans have decided to be proactive again and turn back to management. But this time, they are trying to shift the paradigm and get the patient to be the manager.

Health Innovation’s Jerry Reeves, the medical director for union plans across the country, says hospitalizations are no longer the key drivers of rising costs. Costs are now being driven by ambulatory settings like ERs, outpatient settings, imaging centers, and the outsourcing of diagnostic activities outside the physicians office. A doctor visit would be the low cost solution, but people are not getting access to physicians’ offices, and wind up in the ER, which costs 13x as much to deliver the same services. In addition, Reeves said people are not getting lifesaving treatments and things they really need, because the system is so broken. He is trying to move to value-based health care.

Mohan Nair is a serial entrepreneur now with Regence BCBS, a four-state plan that has been working for last 6 years to help the system change. Regence is trying to invoke a vision of health care as everyone’s community asset: the consumer has to recognize that it’s his money and his future. Although there’s plenty of blame to go around in the health care industry, rather than trying to find someone to blame, Nair says, insurers have to change, and change quickly, altering their centers of gravity to the consumer and helping the consumer make better decisions, balancing medical management with consumer engagement. Of Regence BC/BS’s 3 million members, 30% are already actively engaged in online communities.

Over the past two years, CIgna’s 8.5 million domestic” lives” have already seen a transformation from their old school insurance company to a customer-centric universe Focused on what people actually want from this system, Cigna participates in Facebook, Twitter, Second Life, Eliza, and Intuit (Quicken Health). Cigna patients can download all their claims information in Quicken Health and see what’s been paid, what hasn’t been paid, and what their responsibility is. The application both tells people how much is actually being covered by their insurance, and explains why things are not covered — in plain English. Cigna patients have seen their information made transparent and delivered to them through many interactive channels. However, merely making information available does not necessarily encourage people to change their behavior. You need to have a motivated patient that’s willing to act on the information.

But at least the new system invites the patient in, which the current health system does not do.

Nathan Moracco, St of Mn Management and Budget supports the employer group for the state of Minnesota, and has devised for the state a tiered product with care systems ranked on a cost and quality basis, layered on top of incentives for members to seek the right care at the right time. The state is doing quality management around diabetes and depression care right now, because veryone knows that 5 chronic diseases account for 70% of the health care spend.

Chris Ohman of Kaiser (8.5 million members, ten states,) says they are putting finishing touches on installing their health IT system throughout the enterprise with an emphasis first on clinical care management, and second on the customer experience. Kaiser, too, knowing the numbers, is making big steps forward in chronic disease management, delivering what they feel are better benefits at lower costs.Engagement of consumers is related to this and Kaiser patients are filling prescriptions, making appointments, getting test results on the web, and then engaging with the physician.

Dear Senator Kerry,

Your reported call for “lies” about health care reform to be refuted is essential and requires an urgent response. To that end, may we – British health professionals and patients – respectfully expose those “lies” which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

Continue reading to see the full letter.

PATIENT CHOICE: There is NO “death panel” in the UK NHS or anywhere else in the UK health care sector.
-Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.
-Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it. It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing voluntarily to make their own arrangements for their future, medically and physically.
-Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.
CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems – they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.
CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.

CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.

FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.

INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.
THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.

BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.
The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions. Importantly it gives freedom from fear of the financial consequences of illness.
Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.
The NHS has shown itself to be open to – and often the source of – innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here

Yours sincerely,

Sir George Alberti MD, PhD, PRCP
Past President of the Royal College of Physicians
Dean of Newcastle School of Medicine

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
Professor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK
Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP
Consultant Rheumatologist, UCH
Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men’s Health Forum and member BMA Council

Professor Eileen O’Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy
Health Policy Unit,
Dept Public Health & Policy,
LSHTM, Keppel Street,

Professor Rosalind Raine

Reprinted from Gary Schwitzer’s blog (one of the pre-eminent health journalists and teachers)

As our health care debate has overheated, myths about the Canadian health care system abound. The Republicans and the media are using the Canadian system to criticize everything from the public option to breast cancer treatment as they continue to stonewall any reform. This video, and more like it, might finally change the debate by forcing the American media to get off their arses and go tell the truth about Healthcare around the world, and how it towers over the wretched mess we have in the United States. Too many lives are running out of time.

Why this video? Why now?

In the spirit of truth, my friend Matte Black (@Shoq on Twitter) and his brother took their video camera to Canada on vacation to interview Canadians about their health care system. When we talked about it, I asked him to try to get negative views with specifics for balance. Here is the result. It has been edited for brevity, but the negative views were not removed, because there were none. He could not find one Canadian who thought they should kill the system. These are everyday people. They have no agenda at all other than being patriotic Canadians.

Please watch it and share it with as many people as you can.

Click the button to follow Shoq:

All summer long I’ve been turning myself into an expert on health care reform. I always knew more about health care in the USA than most, because I did the public relations for the first HMO in Arizona and then went on to make health care a big segment of my company”s client roster. So I’ve been hearing about cost controls, socialized medicine, and denying treatment for twenty-five years. I also ran my husband’s medical office.

Then my friend Karoli got laid off last December, and found out she couldn’t afford her COBRA coverage and had to learn how that system worked. Some of the old NewsGang folks started talking about the power of microcommunities to bring about change. So we started USHealthCrisis.com (thanks Maxine Appleby for donating the domain name) as a place we could impart information about the state of health care amidst a financial meltdown.

Since then, we’ve been tweeting, blogging, and using every form of social media we can get our hands on to make the case for meaningful reform. Not “health insurance reform,” not just a bill that Obama can sign and declare victory, but meaningful reform that will give Americans rights to a certain basic level of primary and preventive care.

Today, with the news out of Washington that the Gang of Six is imploding and the Republicans have decided the only way to win the mid-term elections is to sabotage reform, I find my patience with politics sorely tried.

There are a couple of major issues that should be discussed with regard to reform: how are we going to pay for it and how are we going to provide enough primary care doctors in the short term to provide it.Let’s call those the “patient-facing issues.” Behind those issues lie bigger questions of incentives and outcomes: let’s call those the “political issues.”

The patient-facing issues are the ones you and I content with. Can we (or the government) afford our own health care, and can we even get an appointment with a doctor?

But these have been overwhelmed by the concerns of:
1)Pharmaceutical companies who are afraid they will make less money under a new system in which some of their products will not be paid for
2) Insurance companies who will have to cover the sick
3)Hospitals who will have to face the fact that they’ve overbuilt beds and now REQUIRE people to be sick to fill them
4)Politicans (both sides) who are afraid to make a move out of fear they won’t get those large contributions they need for their next races

And sheer whackos who think no one should have anything but them and they should have everything.

It’s enough to make me ashamed of Washington, the news media, and us — the people who sat back and allowed ourselves to oursource our health to a for-profit system that does not, in any way, really care.