After countless months the debate marches on.   Congressional House and Senate bills proliferate.  I have lost track.  It is beyond our comprehension trying to read through each of these bills.

There have been many lost opportunities.  This has never been about health care reform.  This is about health insurance regulation.  If you carefully sift through all the heartache stories and testimonials, you will see the real drama – unexpected hospitalizations.   So the real crisis is coverage of catastrophic loss – astronomical hospital bills.  Routine appendectomy — $50,000.  Complicated heart attack — $250,000+.   Catastrophe loss should have been the starting point.

Insurance is not the answer.   It is the problem.   Insurance subsidizes high costs.

Mandating and legislating involuntary participation in the insurance protection racket is the great irony.  Insurance is the problem.  The simple, but unobtainable solution is to regulate the entire health insurance industry.   Treat these as public utilities.  States already have mechanisms for regulating public utilities.  Rates are set and agreed upon.

Why did the AMA and AARP, trumpeted by the White House, decide to support health-care legislation?  AARP sells insurance.  The AMA speaks for a minority of the physicians in this country.  It is not nearly the omnipotent organization everyone believes.  Physicians are inextricably bound and subservient to insurance reimbursement.

A proper discussion of health care reform separates healthcare innovation, modernization and advances from insurance reimbursement.   These are two separate and distinct discussions.  That is where the all this confusion arises.   Understanding the difference between these two threads is essential.

Regulating medicine is infinitely more complex than regulating insurance.  The worst possible outcome is further regulation and bureaucratization of medicine.  We need more creative, expansive, inclusive and constructive solutions.   Not mandated paragraphs, subparagraphs and subsections.

What is so dismaying to this practicing physician is the paucity of physician input in this entire saga.  How many town hall meetings were conducted by or involved physicians?  How many physicians are involved at the policy level in congressional debate or administrative policy formulation?  The Wall Street cabal has their proxies “fixing” the financial crisis.

The sad truth is physicians are politically naïve.  A physician’s primary concern is the welfare of their patients.    They are not adept at nor interested in the political process.   Probably for good reason.

The missed opportunity started with the financial industry.  The financial meltdown appears resolved.  It is not.  In fact, it is worse than ever.  The “too big to fail” institutions are strengthened by governmental subsidies while the weaker institutions are failing at an unprecedented rate.

So the rich get richer and the poor fail.  Our government is fattening the Monopolies.  This benefits no one.   This is emblematic of congressional failure to grapple with the primary problem facing us today – financial insolvency.    We need a Teddy Roosevelt, not a Franklin Roosevelt.   It is time for vigorous and courageous trust-busting.

In order to promote a “deficit neutral” health care bill all manner of tricks have been incorporated into numerous bills.   The simple truth is, most unfortunately, there is no free lunch.   Health care costs will rise.  But health insurance premiums are rising at a faster rate.

And in their infinite wisdom and courage, Congress fails to pass legislation that would have repealed physician Medicare reimbursement cuts.   So $230 billion was “saved”  on the backs of the very providers that are the heart of the system.   What happens?  Fewer physicians will participate in Medicare.   And you want Medicare for all?

The risen-from-the-dead public option is back again.  What is the public option?   There is an implication this is a “free program.”  Just like the Internet.  Or at the very least, this will compete with other insurance companies thereby lowering rates.    Dream on.   This is not going to happen without severe regulation.

What would you be willing to pay for the public option?  $100 per month?  $500 per month?  $1000 per month?   What if the public option is your only choice but the rates are no cheaper?  Even my man, Howard Dean, agrees that tighter regulation of the health insurance industry would obviate the public option.   The public option is not the rate limiting step.

Most unfortunately this serious public debate has morphed into a team sport — the Red Team versus the Blue Team.   Who scores the most points?  Whose side wins?  Let’s crush our opponent.  Is this yet another referendum on the President?   We need to win one for the new Gipper.  In this game, no one will win.    Sad sack Harry Reid will try to appease everyone, and satisfy no one.

You can fool some of the people all of the time and all of the people some of the time, but you can’t fool all of the people all of the time.

No health-care bill will be better than a bad bill.   There is a notion that even bad choices are better than no choices.   This will not be true for health care.

Our market-based economy is not dead … only severely wounded by pirates and naves.   Do not confuse the financial system with the medical system.   Now is the time for transformative changes not sclerotic mandates.  You deserve a more articulate answer to the question: just what is the problem?