Seems like we heard capitulation from the White House today. Wait until October says the President. I have been Waiting to Exhale and now maybe the more apropos title would be Waiting for Godot: will we ever have a passable bill. Thank goodness at least for Cooler Heads to prevail. I was very nervous that we would have a rerun of the Patriot Act or TARP or Stimulus Bill I or II rammed through with very little thought to long-term consequences. What is the solution to Fixing Healthcare? I think we docs are not really able to make rationing decisions at the bedside: some say it's unethical to withhold a treatment merely because it's expensive. We as a nation haven't undertaken the hard task of setting limits on the value on a human life. Money is ultimately a finite resource though our regard for human life is infinite. The infinite value of a human life is all well and good but it's not sustainable. In clinical practice we are amazed daily by the outliers of expensive care. I wonder if these cases really consume as much money as we think they do. How would we docs feel having to justify the benefit of dialyzing a 90 year old or performing hip surgery on a cancer patient (Obama's example)? I have a feeling we wouldn't like it any more than we like having to talk to insurance companies now to justify the things we do. Wasn't managed care supposed to rein in costs? What happened to that model? Does it work? You have a set of call center people that you have to deal with to get any procedure you want and you have a medical director that denies the most expensive procedures that you have to beg to get the big stuff authorized. You have to wait for access to specialists and special procedures. You theoretically have programs to limit access to the most expensive medicines? Is this the death of managed care? Is the HMO dead to paraphrase Nietzsche only to live on for another thousand years as a shadow of its former self? People hate HMOs but I sure saw a lot of HMO patients today. Turn the whole US system into managed care? I missed that headline in NYT. I think for starters we need to rein in drug costs. There needs to be some sort of regulation on prices. Walmart Target CVS AARP and Walgreens could join forces. Where's Medco when you need them? They regulate hospital and physician prices why not the drug companies? Physican and hospital fees--what to do about those? Well why does the MD and hospital part go up every year? Or does it? Until you have the level of oversight for each procedure each patient sort of a shadow medical system analyzing the practices of every physician I don't see how you can limit the ordering of tests visits or consultations. Let the arguments in the doctors' lunch room continue.