I was discussing my health insurance with my broker today, looking at possible changes for 2009. Our prices for 2009 have risen about 250 dollars a month, which is 3 grand a year.

So of course it becomes time to review alternative plans, including high deductible plans, which can be coupled with HSA's to give one a much lower premium.

As we discussed insurance, my broker was talking about the government coming in to take over health care reimbursement, and to become a major payer in the system. He pointed out that many doctors don't want to take Medicaid or Medicare because the reimbursement levels are so low that they can't work profitably. I know this is true because I've talked to various MD's, including some family members.

So if what they're going to do is basically expand Medicare type coverage, what's going to happen to our level of care?

Well, you get what you pay for.

I'd bet that if they mandate reimbursement rates at Medicare levels, we'll see a serious physician shortage, as many MD's retire or change career courses. The remaining physicians will have to find a model that is profitable for them, that makes it worth the headaches that go with medical practice. Whether that will be good for the patient remains to be seen. But I wouldn't bet on it.

Cutting health care costs sounds like a noble endeavor, and I always hear it framed in terms of "making the system more efficient" by going to electronic claims and cutting down on waste. But what is "waste" when it comes to care? Is it the test that rules out something that is in the differential diagnosis "waste"? What exactly IS an "unnecessary test"?

Dentistry (my field) is easy compared to medicine. Teeth are simple little body parts, really. And they're exposed to our direct inspection. And you can live without one. Or even two. We know how to replace them, and we know what sorts of things can go wrong with them. Ever hear of cancer in a tooth? No, and you probably won't.

By comparison, the heart is such a complex organ. So are the lungs. So is the stomach, or the intestine, or the pancreas, or the liver, or the brain. It takes a lot more to figure out what's wrong. It's not simple, by any stretch.

If lowering costs means decreasing reimbursement across the board to Medicare levels, I'm afraid that we're going to suffer a great deal in this country with respect to the quality of our health care.