Everyone is talking about the need for health care reform. I agree. I am a retired general practice physician. After 48 years in mainly solo private practice, I feel that I have some insights into parts of what is needed to reform our medical care system.

1) We need to have mandatory, affordable and basic insurance coverage for everyone, regardless of health status. (Whether “everyone” includes illegal immigrants and/or non-citizens is debatable. They are all covered now if they go to an emergency room, without question, and at public expense. If it is not totally inclusive or easily and cheaply afforded, the young and healthy will opt out while the seriously at risk or ill will flock in).

2) Health insurance companies must be either nonprofit or limited to a relatively low-profit and overhead expense status. (Whether a government-run public or now newly named consumer system is desirable or not is debatable, too. The concept is reasonable on the surface, but I fear it would be subsidized by the government so as to make the premiums so low that private insurance would be driven out of business, ending up with a one-payer system, which is neither totally desirable nor advisable.)

3) Fraud in Medicare, Medicaid and private insurance should be eliminated. (This can and should have been pursued without new legislation. Enforce the law. Add new law as necessary.)

4) Remuneration for hospitals and medical providers should be fair and equitable. (Hospitals and physicians have been accused of charging too much by many, including the late Sen. Ted Kennedy for 30-plus years. The bulk of hospital overhead is labor costs, as is the largest expense for most physicians. The itemized “charges” on hospital bills are mandated by the government and should not be equated to what the hospital gets paid, unless you are unlucky enough to have no insurance and pay the whole bill yourself).

5) Medical malpractice insurance costs must be constrained by federal law, as they are in California, by state law. (The scanty pilot programs proposed by the government are too little, too delayed and inadequate.)

6) Provision for the continuation of the private practice of medical services should be reasonably assured, if providers so wish. (Federal suggestions of how to organize medical delivery all emphasize Kaiser, Mayo Clinic and the Cleveland Clinic, etc., which have all salaried providers, or on the state level, with attempts to pass legislation to allow the corporate hiring by hospitals of physicians to practice medicine. Corporate medicine in small towns and rural areas is difficult to organize.)

7) Ideally the government should help assure, in some way, an adequate stream of new health care providers, especially nurses and physicians, preferably of American citizenship and/or legal residence. (Costs of education are so high, that the minimum 11 years to 13 years of college and graduate training at up to $40,000 a year for some specialists is so high, many students would never enter the medical field. A required time of pay-back service may be one way to help supply services in underserved areas, but let your imagination run wild. Train foreign students, but encourage them to raise the level of care in their home countries, if we can afford to let them return.)

8) Medication/drug costs should be controlled. (Pharmaceutical companies deserve a profit and to compensate them for their research and development costs, but their profits and profit margins appear almost obscene and their subsidies from the government are largely free to them.)

9) Attempt to provide free choice of private providers. (Lip service is given to this, but nothing approaching a guarantee. Instead, the provision of a proposed public option threatens the partial or complete dissolution of private insurance and free choice of provider.)

10). Keep total costs and tax increases to reasonable and honest levels. (Difficult to do. Perhaps phasing in over several years more than projected, and possibly doing only parts each year.)

While most of the above points have been discussed, and some changes discussed or made in Washington, none of them has been really seriously fully approached. I do not mean to say this is easily done. What we need is reform, not just change. Change is not necessarily reform. What is proposed is only change, not true reform!

Let our president, our senate and our House of Representative pass some reform, not just changes, as a start, not just pass some meretricious changes that will do little to reform but will cost an inordinate amount of money.

(Miller lives in Napa.)