If you are having difficulty understanding health care reform, you are not alone. When Franklin D. Roosevelt was asked why he did not include health care reform in his New Deal Programs (1933-1936) to speed economic recovery during the Great Depression, he responded: “Because I can’t explain it.” Therefore, if FDR could not explain it, you the reader and I should not feel bad about not being able to explain it either!

Some people already have health care insurance, such as senior citizens who have Medicare beginning at age 65 and children ages 1 to 19 who have the Children’s Health Insurance Program, better known as CHIPS. This leaves folks who are ages 21 to 64 years of age. For those who have full-time employment, medical insurance may be offered by the employer. However, fewer companies are offering insurance because of the expense involved. And those companies that do offer medical insurance are increasing their premiums to a point where it is not affordable any more.

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I will not be surprised if we find out later that flu infections this year have more systemic consequences than in year’s past.

By “systemic consequences,” I mean that not only does the virus cause general aches and pains, fever and cough, but it can also cause pneumonia, meningitis, myocarditis and pericarditis. The H1N1 (swine) flu virus has already been reported to cause more viral pneumonia than regular flu. Some who do not understand viral infections may be thinking that treating this simply requires an antibiotic. However, a true viral pneumonia is not cured by an antibiotic, since antibiotics are for bacterial infections and may only be slowed by antiviral agents. For the most part, we have to get over viral infections on our own, and physicians and hospitals help support such a person while they get over the infection. If the person has a lot of sickness or other reason to have a poor immune system, they may not be capable of getting over it.

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As this country starts moving towards health care reform in Washington, D.C., it is necessary to understand the health care issues being debated, the terminology used and formulate some kind of opinion. After all, whatever legislation is passed, it will affect every American one way or another. At the present time, health care is almost a privilege — that is, for those who have health insurance. It is estimated that approximately 40 million Americans do not have health care insurance. Certainly we all have rights guaranteed by the U.S. Constitution; however, health care is not one of them.

Before we embark on this journey of understanding health care reform, one must examine his or her own philosophical and/or religious beliefs concerning self and one’s fellow human being. What are the moral and ethical implications regarding health care? Am I my brother’s keeper? Most religions and cultures have a reverence for life, and therefore will help another who is sick and in need of medical care. Would you throw a life preserver to a drowning man? If your neighbor was sick and you had the means to help, would you do so? If you were sick and had no health insurance, would you expect your neighbor to help?

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If you have been in the emergency room or hospital lately, you have probably received a bill that was much greater than you imagined it would be. If you have insurance contracted with the hospital or if you have Medicare, you will see an initial bill and then a bill that shows the discounted price. This price will be used to determine both your and the insurance company’s responsibility.

Your responsibility will depend on the amount of your co-payment and deductible. The deductible is the amount you have to pay up front before the insurance pays anything. After the deductible amount, you have a co-payment, which means you pay a percentage and insurance pays the remaining balance. The co-payment and deductible are not determined by the hospital but are the arrangements you have with your insurance company. The portion owed by you is just as important as the portion owed by the insurance company. Together, the insurance payment and the patient payment complete the bill. Some people are fortunate to have more than one insurance, which may pay even more of the total or perhaps all of it.

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I watch the debates about health care reform, and I can’t help but to wonder why someone hasn’t said anything sooner. Many issues are not new, yet people discuss them as though they’ve just happened, like the recession. Doctors have been experiencing a reducing amount of income for many years. Doctors lost the ability to spend time with their patients years ago, when decreasing payments for services and rising overhead forced physicians to increase the number of patients seen per day to help slow the declining income. Doctors have not been able to increase fees because insurance companies have set charges for physicians, so this cannot be blamed for the rising cost of health care.

Many people look at physicians and talk about their income like it is something that is more than enough or more than the profession deserves. If so, imagine what would happen to the current lack of availability of doctors if you took this view and reduced incomes for physicians. Few people have to go to school and training for as long as physicians. It is difficult to find someone who will go through four years of college, four years of medical school (commonly year-round), three to five years of residency, then, if sub-specializing, often four more years. If doctors make so much money, as some suggest, then why aren’t more people trying to become doctors, and why are many doctors not pleased with the way they are currently being paid for providing care? Also, with the cost of education, many in training stay away from the lower-paying jobs.

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Any budget, even your personal budget, has to do with the money that comes in minus money that goes out, ending in a net plus, break even or loss. The money coming in to a hospital cannot be decreased without threatening the closure of hospitals that take care of a lot of patients who have little or no money. Certainly, hospitals in areas where they are making large profits are not in this category. Thus, it would seem that the government should get involved in helping participating hospitals reduce the cost of goods purchased. For instance, if suddenly everything you purchased cost half as much, you could cut your income in half and still be neither better or worse.

So, for hospitals that are having legitimate trouble meeting their financial obligations due to a disproportionate amount of indigent and low-paying patients, it would make sense to help them reduce the amount of money spent on providing that care. I am disappointed that no one is addressing the issue of the cost of giving care raising the cost of getting care and assisting those with this part of the equation. Many have suggested that is because of political issues such as lobbying from large corporations that provide health-care products, but I hope this is not the case. It is well known, for instance, that the VA hospital system has some of the lowest costs because they purchase for all of their hospitals, providing a depot of lower-cost products. If there was a federal depot from which participating hospitals could get high-grade, lower-cost products, it would help to reduce the cost of providing care.

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I was talking to one of my patients and asked her which fast-food place she liked the best. I then asked her if she ever went to that same place when she was out of town, and she said she did. She, like many of us, have come to expect the same menu, prices and quality when we go to a chain restaurant, whether fast food or high-end.

I have often done the same thing without even thinking about whether the product would be the same in another location. Recently, I went to Montreal, Canada. I thought it was reasonable to think that product comparison in a French community with a single-payer medical system and high taxes would be appropriate for the purposes of this article.

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How do you take a health-care industry that has for years been the pride of the United States and cripple it? You set up unreachable goals making the cost to reach those goals also unreachable, then throw in a bunch of opportunists hoping to make money off of the process, and you get what you have. The reason the problem is so complicated is the mixture of causes of the problem. One is the expectation of many to receive care that is 100-percent correct 100 percent of the time — to leave no stone unturned, even if the symptoms do not warrant the work-up, and to provide that care even when the chances of survival are minimal. Many like to think that even a 1-percent chance should be pursued, even if this means exorbitant costs.

How do you put a price on a life, or a loss of limb or ability? The truth is you can’t, but you have to anyway. This is not unprecedented, in that the same thing has happened in other industries. Workers’ compensation has put a price on just that. In order to make industry at least somewhat responsible for losses suffered at work, workers’ compensation has values placed in terms of dollars. Do these dollars represent the worth of the claim? In many cases they do not, but dollar limits were placed in order to allow industries to survive. Workers’ compensation’s monetary values are available to let people know what is expected from a loss. A decision was made to protect us from the loss of industry, which would be a far greater loss than the loss suffered by the individual. To insure the industry is doing everything it can to limit loss, the government has set up Occupational Safety and Health Administration and Department of Health and Environmental Control standards. The bottom line is that limits were set to help industry survival.

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I know you are probably thinking that I want you to have insurance because physicians will benefit from this. However, we are going to discuss how you benefit more from having insurance in ways you may not have considered.

First of all, you need to find out what the maximum income level is to qualify for Medicaid, especially since there are more people out of a job. Medicaid helps pay for medications and sets charge limits for hospitals and doctors, so it is certainly to your advantage if you qualify.

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My wife and I are members of AARP. I know, you think I’m not old enough for that, but they let you join at 50 years old and, yes, I turned 50 this year. Simply reading the newsletter they send out is an admission that I am getting older, so I turned to it reluctantly last night upon the recommendation of my wife. On the front was the title of the cover article, “Where have all the doctors gone?”

Certainly, this intrigued me since my first thought was one of being left out because, after all, I am still here. Where did who go, and why? Maybe there was some haven dedicated to physicians, and nobody told me. But alas, it was not.

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