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A free market place for Americans to choose their health care, affordable healthcare for every American; these are the promises and mandates for reform of our healthcare system. But amid the usual concerns about paying for it, taxation of citizens and employers, as well as a return to HMO horrors, there are deeper concerns being discussed as doctors and lawmakers speak out on how to overhaul the healthcare we so desperately need. Long before the mayhem at town hall meetings over end of life counseling and taxpayer-funded abortion there were the president’s comments and physician comments alike on reforming healthcare; for example doctors talking about the performing of 3 MRI’s when only one is really needed. Both making the healthcare debate a referendum on obesity; doctors mentioning the now well-known doctor Oz’s comments about walking 30 minutes a day and president bringing up school lunches, even though with healthier food choices in schools and more frequent and rigorous gym classes there is not only no change in childhood obesity but the next big idea to come out of anywhere is building more sidewalks. Congress, in an effort to pay for insuring every American, proposed placing a tax on sugary drinks like soda. However the most disturbing things came from Obama’s first town hall meeting and first ideas on a healthcare plan. Disturbing ideas that amounted to rationing care, sticking with the conventional methods, limiting procedures in order to cut spending.

While healthcare reform takes shape and it looks like the public option, or what American’s shrewdly call the government option, seems to be off the table many are still concerned about what this reform means for them, what lifestyle choices could raise their out of pocket costs. Some speculating those choices could include so called high risk activities and medium risk sports; others are concerned about keeping the coverage they have as incentives given to employers by the public option become too good to pass up and their employer chooses to make the change from private insurance to whatever form the public option takes. Other ideas than the public option have also been brainstormed a bargaining co-op of sorts consisting of the uninsured that could then negotiate with private insurers for coverage, or a consortium of doctors working to keep costs affordable and provide help to may now uninsured. The latter two ideas speculated not to work a co-op of uninsured being likened to a neighborhood going against big utility. While a group of doctors working together to lower costs is more popular with the public, it doesn’t take long to wonder when does it become more about bean counting and less about medicine? Still others looking at the healthcare debate have asked is this really a costs game or is it about a shortage of doctors, particularly those specializing in family practice, and the 43 million uninsured projected to flood the system?

Long before former governor Palin was making comments about death panels there was a pallor, a tone that radiated negatively about the healthcare debate and healthcare reform; hearing doctors talk about excessive procedures, the importance of healthy living, the president stating the only way to bring down healthcare costs is to control obesity, left people, still leaves people, with the sense they were going to be forced into making lifestyle choices and changes rather than exercising their freedom to do what’s right for them. Leaving people with the idea that if you engage in high risk activates and medium risk sports healthcare will be less attainable. More unsettling is what has been left out of the president’s remarks on obesity, for example, much of the key to cutting costs of obesity related illnesses is preventive care, early detection and control of said diseases; something only truly possible with health insurance. Likewise it is all well and good to talk about trimming costs by eliminating excess procedures, but when you are a patient, you want that extra MRI to be sure something wasn’t missed, you want that extra X-ray for them to look again and be sure they got all of the tumor, or to make sure you don’t have a broken bone or particular disease. Statements like these also imply a fundamental change in medicine, that there will be a minimalist approach to performing procedures as it pertains to making a diagnosis; they also to fail to take into account the many times arduous process of getting a diagnosis of sometimes rare diseases.

The TLC series mystery diagnosis spotlights cases just like this including a toddler with a rare disease in which he lacked the cells in his colon that tell it to move; thus stool was getting backed up. After surgery to remove the defective portion and insertion of a colostomy bag the young boy was on track for a full recovery, and with 2 more surgeries would have a reconnected functional colon. But before his diagnosis it was numerous trips the pediatrician, numerous trips to a pediatric gastroenterologist, persistent, boating, pain for the child and his mother was told for 3 years it was everything from normal constipation from transitioning to solid food, to it was a psychological issue caused by pain when passing stool, before an ER doctor found the real problem. Another child had an arm amputated due to what was originally thought to be cancer, and only when the same symptoms appeared on the other side of her body did another doctor diagnose her with FOP a rare disorder that turns muscle tissue to bone. A woman suffered for decades with extreme pain and bowl issues, saw a double-digit number of doctors before being diagnosed with an autoimmune disease causing inflammation throughout her body, particularly intestinally. Once put on a steroid regiment she was able to control the symptoms and her quality of life improved exponentially. The point being how much of the doctor hopping required to find the truth would be available under the restrictive plans now labeled Obama care? At the same time, with horror stories of incompetence making headlines doctors removing the wrong limb, doing the wrong surgery on the wrong patient, leaving instruments inside patients, a doctor recently in court on malpractice charges, after having his license suspended or revoked in multiple states, for using a kitchen spatula during a surgical procedure, it is all the more important to have many choices when it comes to doctors and care.

Additionally, for doctors, what happens when a more unconventional treatment is called for in treating the patient in front of you, correcting various deformities in children, giving an active adult a different kind of joint replacement that’s going to allow them to keep their quality of life, a cancer treatment that would be less invasive, more successful for the individual sitting in your office? And how does it not become just like HMO penny pinchers refusing to pay for medications or procedures? What the president and congress budget watchers need to understand is costs can and will be reduced long term when people have a primary care physician and stop having to use the ER for the same function, when sick people, people with chronic diseases can get the care they need as they need it rather than postponing it until they absolutely must see a doctor then getting a medical band aide on a lager issue at a free clinic. Because, unlike a disgruntled doctor on c-span saying people on entitlement programs tend to overuse them, people on entitlement programs simply use them, and begrudging first time mothers looking out for the life in their hands or people with undiagnosed symptoms looking for relief does nothing for the health of this nation. Not only that but, we have seen all coverage plans work in individual states and as long as everyone had coverage it did bring down costs.

Other concerns of the American public surrounding the rationing of care not only have to do with end of life issues but care issues for older Americans. Will they be able to get life saving, quality of life insuring procedures done or will they be denied due to cost because the person has passed midlife? Further will they be denied because of a person’s lifestyle choices like smoking, sugar and junk food consumption, lack of exercise? Closely related to that is with the push for healthy living coupled with the recession economy, how long is it before health becomes another discriminatory tool in an already well arm arsenal; how long is it before employers refuse to hire an obese person or person who has a chronic disease fearing the costs of their healthcare? As it is employers have made headlines for firing smokers, creating gyms, offering yoga classes providing incentives for those who participate in these activities.

Congressional republicans are also raising questions about the hasty nature of healthcare reform and the deadlines president Obama keeps imposing saying it is all too fast, which almost anyone would agree. He seems to be trying to ramrod healthcare reform through as fast as possible, doing in a couple of months or a couple of years what will more likely take a decade and should take that long. Leaders and lawmakers need to slow down look at what works in other nationalized healthcare systems; pull an idea from here and over there and combine it with things uniquely American to create what is needed here and only here. We need to look at what can be done to curb the long waiting lists for doctors and specialists found in countries with socialized medicine, curb the seemly lower quality of care for those only public healthcare vs. private, maintaining the things that draw people here from places like Canada and avoid situations like those you find in Britain where websites detail how to pull your own tooth.

Healthcare reform is something that needs to be phased in, taken in steps not in one lump sum of legislation, and it begins with the referendum on existing insurance company policies, making sure they cannot drop you if you are sick, making sure they cannot override doctors on procedures and medications. Then the next task should be rounding out the coverage given by Medicaid and Medicare for everyone on it child, adult or disabled individual, to include dental and eye care. Next creating and offering affordable options specifically for small businesses so they can insure workers, eliminating the higher costs to said businesses because they are providing for a handful of workers, a couple of hundred rather than a couple of thousand and finally creation of a public option that adheres to all the standards to cover the remaining uninsured. And doing it slowly makes sure laws are followed less things fall through the cracks. Otherwise how is it not a form of death panel if you cannot get what you need because you are older, can’t afford the premiums because you, smoke, like cheeseburgers and don’t walk 30 minutes a day, your public option health coverage won’t cover the treatment you need because its out of the norm? And no one should be adding tax anything considered food; yes we need healthcare reform but it must be done right. If you smoke you deserve healthcare, if you like cheeseburgers, you deserve healthcare, if you don’t walk 30 minutes a day you deserve healthcare, if you are an alcoholic or drug addict you deserve healthcare, treatment being top on that list. Why, because this isn’t Lord of the Flies, survival of the fittest; it’s the United States of America.

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