It looks like we were right last month about how the Swine Flu was going to play out. Nothing really exciting or explosive. In fact the CDC has significantly reduced the indications for treatment and testing, and simplified the overall management of this problem. We'll just have to wait and see. And if you read last month's column, I need to let you know that Barbara still hasn't given me a foot massage. Something about the next millennium...

I'll have to admit that it wasn't that difficult to predict where the new "pandemic" was headed, so today let's tackle something a little more challenging: universal healthcare. I get asked about this a lot, about where I think we are headed with regards to healthcare in this country. I'm sure every physician in the area is asked the same questions.

First of all, the easy part. We do have a problem in this country with access to healthcare, and to affordability. We see that every day in our clinic. And I saw it every day that I worked in the ER, starting in 1976. That hasn't changed, and now seems to be getting worse. We haven't figured out the answer, and I haven't heard any good solutions being put on the table. There are a lot of vested interests here, which usually means the outcome, if any, will probably not be good for the consumer. In this case, that would be us, the patients, those needing healthcare for a wide variety of reasons.

We've all heard a lot about the Canadian healthcare model, and that of Great Britain. I'm not going to spell out the pros and cons of those systems, and there are a lot of each. You can easily go on line to read lengthy opinions about this, and can draw your own conclusions. But drawing those conclusions will be difficult. I think everyone involved with this issue will agree that no one has yet to get this right.

So what can we draw from here? How can we get a glimpse of where our new administration is likely to take us? It certainly seems we're headed somewhere, that the status quo will soon be the status gone. So let's take a look at something we know about, something with which we are very familiar: Medicare. This might be appropriate because in a sense it is universal healthcare for a large and growing part of our population. And since it's owned and operated by our government, we might get an idea of what a larger, more pervasive healthcare program might look like.

Now, those of you who are happy with our Medicare system, please raise your hand? I'm not counting very many. And among physicians, I'm not counting any. Why is that? What makes this system so difficult to manage, both as a patient and as a provider?

This is a tough one. We began accepting Medicare patients at our clinic several years ago. We did this not because it was the smart thing to do, or a financially wise thing to do, but because it was the right thing to do. I'm not patting ourselves on the back here, but we did this out of concern for our patients, their parents, and our friends who are now on Medicare and have a dwindling number of healthcare options. Most providers in the area will not see new Medicare patients, and some will not see any Medicare patients. The reasons? Here are a few:

- Mountains of paperwork, both to enroll and to stay enrolled

- Difficult and time-consuming documentation, both for the providers and the billing office

- Marginal (that's a charitable term) reimbursement. Providers actually lose money when they see some Medicare patients

- The constant threat of audits and significant financial fines if you don't cross all of your "t's" and dot your "i's"

- A significant level of helplessness. The government controls the levels of payment, and can easily and quickly ratchet down those levels. Providers have little recourse, and savvy politicians will quickly point out that this is a reasonable and "fair" way to save the program millions (billions) of dollars.

- The ultimate "hammer". Those providers who have decided not to participate in the Medicare program can not treat Medicare patients, even if those individuals have been their patients for decades and specifically want to see them. Think about that for a minute. That's pretty frightening, and bothersome. I found it hard to believe, but a call to our Congressman confirmed the fact.

But there's some good news here. We can avoid a lot of the mistakes and pitfalls that other nations have made, and that we've made ourselves. Hmm... I wonder if that will happen. It seems there are those among us who think the road we're on is paved with yellow bricks, and there's a wizard waiting for us at the end of it. I wonder...