Healthcare Reform. To do it is frightening. Not to do it is frightening. Republicans and Democrats each have their own perspective, contributors, and ulterior motives. Special interest groups abound, each allegedly out for itself.

As a physician, I am in a special interest group, and could certainly be accused of having an agenda. Docs, however, are the core of medical care and need to be on board. Talking to colleagues and reviewing meeting and discussion group comments, there is certainly not unanimity, but there is consensus. Docs more or less want the same things that everybody wants, including the president. We just happen to have an insider view of what might and might not work.

To get what we need, the healthcare system needs to go on a budget, especially if we want to save enough money to sock away a trillion dollars toward subsidizing care for the poor. Diminishing costs can only come from a few areas:

Efficiency

Diminished administrative, bureaucratic, and legal costs

Be a more responsible, healthier society

Limiting/Rationing/More wisely utilizing resources

Pay everybody in the system less.

There are many ways to accomplish the above, some more or less distasteful than others, but most requiring discipline or sacrifice. I have room to just speak to a couple of these items.

Doctors are getting quite used to being paid less. The gravy train rolled out of the station long before I received my degree. But remember, clinicians are paid about 20 cents of each health care dollar. Before another government funded program comes our way, check out what we already have.

While caring for the elderly, infirmed and downtrodden is a noble thought, a warm heart does not pay the bills. Medicare marginally pays the overhead, while each Medicaid patient loses money for a medical practice. Sadly, more and more doctors just say “no.”

Physicians don’t like to limit care. Actually, we fight insurers daily to have tests and treatments allowed. But those tests and treatments that we do reluctantly are those done “defensively.”

Physicians would like to be able to limit that behavior without putting our necks on a block. Medicolegal reform is certainly a critical ingredient to meaningful reform. The threat of a lawsuit coming out of nowhere, often without merit, is forever in the back of every practitioners mind.

Cost of insurance (think $) and defensive medical practices (think $$$$) are real financial burdens on the medical system, to be shared by everyone. The unquantifiable is the crushing effect the irrational tort system has on clinicians’ morale. I think doctors would better tolerate the pressures of declining reimbursement, increasing overhead, and abundant regulatory interference, if the threat of legal pot shots was less prevalent.

Mr. Obama’s speech of Sept. 9 was motivational and had the right spirit, but the devil is in the details. It was refreshing to have a Democratic president bring up the possibility of tort reform in public, albeit surely to the trial lawyers’ shock and chagrin, as their generous contributions helped put him in office. Thanks for that Mr. President, but I’m not holding my breath.

Roger Blauvent lives in Newcastle.