The issues need further debate, and physicians need to become involved in a meaningful way. We need to realize that it is overly simplistic to think that we can eliminate government from the picture altogether. If we are to rely on market forces, we clearly need government regulation to make sure that these forces operate in the public interest. The recently passed Kennedy-Kassebaum bill, which guarantees insurance portability for people who change jobs, is a good example of effective government regulation. We must come to terms with the fact that not all regulation is bad, particularly when public interests such as health care are at stake.
Current rhetoric has power moving from the federal government to the states.
While some states such as Minnesota, Oregon and Washington are developing innovative approaches to expand coverage to the uninsured and to ensure quality of care, many other states are doing little. If oversight of Medicaid and insurance regulations are completely turned over to the states, we will see extreme variation in the numbers of uninsured patients, as well as the quality and accessibility of health care. Each of us will need to exercise responsibility as citizens of the states in which we live and become more involved locally to ensure that medical practice is conducted in the best interest of patients, and that vulnerable and underserved people have access to needed services. In this model we may need government as an ally to regulate the economic forces and allow us to keep the well-being of the patient as our first priority. While we experiment with new forms of health care payment, we should realize that these changes affect not only physician practice patterns, but also patients and their families.