September 16, 2007 12:35pm

I am always being told that I am going into medicine at the "right time".

Am I really?

First, is there ever, truly, a "bad time" to go into a field that will never lose its usefullness? Is it ever a bad time to go into something, such as, the funeral business? "Oh, this is a bad time for the funeral business. Not many dead people these days."

On the other hand, do people think this is a particularly good time to go into medicine just because healthcare is a hot topic? Wouldn't that mean that now is also the time to get into the mortgage business?

I worry that I am of the wrong personality type to go into medicine as it is now, and how I fear it will be in the future. With the 2008 election looming and the she-devil Hillary presenting her absurd plan to get our government even more involved in healthcare, I feel like senators will be making decisions on a patient's health more than the physicians. I already see shades of that when Prescription A isn't covered on someone's formulary, but Prescription B is...even though I know that Prescription A is waaay better for this particular patient.

Why are we so willing to give up our freedom in choosing our care? Because it is perceived to be "free"? It is not free. Imagine making about 25% less than you do now. Look at your paycheck after taxes. Take off an extra 20-25%. That's what you would take home. Lovely.

The expansion of SCHIP and its adorable commercials with cherubic children asking for their school shots is equally nauseating. They don't show the not-so-cherubic 25 year old still-living-at-home-while-attending-community-college-and-working-at-Starbucks who is also eligible for this "children's" health plan. They also fail to mention that the money for it is coming directly from Medicare Advantage (more like DisAdvantage).

And in the frightening statistic of "45 million people uninsured", why do they fail to mention the percentage of them who are illegals and, therefore, should not be eligible for anything anyway! Or what about those who have health insurance available to them through their work but they choose to not get it because they think they are young and healthy and would rather buy an xbox? Let's look at more realistic numbers before we decide to create major overhauls of the current system and give our government yet even more control over our personal health decisions.

Even more absurd is the notion of a person who has made his money by suing the healthcare industry an office in the White House and the authority to decide that everyone needs to see a doctor. Preventive care is all peachy keen in theory, but the jury is still out on the cost effectiveness of it.

I don't know what the best solution is. I do know that the ones currently being presented aren't it.

My idea? Everyone purchases and super duper high deductable insurance plan and then gets to put before tax dollars into a health savings account that rolls over from year to year. For most people, this will get you through your yearly physical, the occasional Tylenol (just save your receipts and you can be reimbursed from your HSA), a minor kitchen accident, and a sinus infection. If, heaven forbid, you get really really sick, you will run through that deductable in a New York minute and your insurance will kick in.

The truth is that most people, particularly young people, don't get very sick. I know as well as anyone that there are exceptions to that. But I don't think anyone can argue that the majority of people under the age of 40 or even 50 do not have major medical problems.

And then on the other end of things is the money spent on caring for the elderly. Maybe we, as physicians, need a more realistic plan for what to do with our patients. Why do a test on someone when you know you will not do anything about the result? For example, someone is 85 years old, has diabetes, hypertension, and conjestive heart failure. If they have colon cancer, they would not be a good surgical candidate. So, why do a colonoscopy on them? Why put them through the torture of that, and the expense of that just to say "yup, you have a tumor. no surgery for you, though." Your management of them would be no different if you didn't know what was wrong with them to begin with anyway!

I saw a woman a few weeks ago in the office who had a very slow heart rate. She is in her 70's, demented, and sits in a wheelchair all day, stares at the ceiling and hums. The only thing the cardiologist could recommend was a pacemaker and an implantable defibrilator. After explaining to her family what all of this would mean, they quickly agreed to send her off for surgery. Her daughter was wearing a t-shirt that had "You Must Be Joking" printed on it. I sincerely wished she understood the irony of that. Those were my thoughts exactly as she was telling me how she just wanted to get mom's heart better. "You must be joking." Mom doesn't know who you are! $30,000 later she will go home from the hospital, just to continue sitting in the chair, staring at the ceiling, and humming.

I wouldn't begrudge her right to have this surgery, but I do wonder about the ethics of it. I also wonder about the ethics of spending that kind of money on someone who is in her condition. On the other hand, it is the right of her and her family to go through with this, as idiotic as it may be. But if we lose our personal choice in our care by hanging over the responsibility of all payment to our government.....would she even be able to make that decision? Would the long shot ever even be tried? Doubtful.