Editorial Note: The National Conferences on Primary Health Care Access on April 12-15, 2010 will conduct the Twenty-first National Conference in Koloa, Kaua’i.

Doctor Allan Wilke (pictured below) of the University of Alabama’s medical school in Huntsville is a permanent member of the faculty of the National Conferences. His forum was launched after the election of President Barack Obama, who has made health care reform a central goal of his administration.

National Conference participants and the public at large are invited to contribute their thoughts and reactions.

ALLAN WILKE, MD: MAKE AN OMELET OR RAID THE REFRIGERATOR FOR LEFTOVERS?

The economy is in the crapper, our health care system is broken, we’re fighting two wars half a globe away, and the new president will be inaugurated in less than three weeks. The Chinese symbol for “crisis” is the same as “opportunity”, and if this isn’t a working definition of crisis, I don’t know what is. Let us live in interesting times!

Over the years I’ve become cynical about the prospect of changing our health care system. This goes back at least to Clinton’s first term and the Hilary Clinton-Ira Magaziner debacle, and I’ve been coming to the National Conferences on Primary Health Care Access more for condolence than insight.

Earlier this week, I participated in one of 4000 (yes, 4000!) meetings of physicians, patients, other healthcare workers, and public officials organized by the Obama-Biden transition team to discuss what’s wrong with medicine in America.

The cynic in me was saying, “Barack is throwing us a bone.” But I went anyway, and I was very surprised to find myself in a room with 40 other physicians, primarily primary care, but others, too, and to a person, everyone complained about how bad it was. The main issue was lack of access to care, but there were other concerns.

A radiologist joked about defensive medicine and how he’d have a lot fewer partners if we in primary care weren’t trying to cover our asses. An ER doc complained about patients using his ER like a private office. Others complained about patients not taking personal responsibility, insurance companies jacking up premiums and deductibles, the usual stuff. It was all very refreshing.

We’ve all heard the litany of problems: skyrocketing health care costs, large medical bills forcing patients into bankruptcy, US manufacturing firms paying twice as much for employee health care as their foreign counterparts, problems with healthcare quality, 47 million Americans without insurance, too many specialists and not enough primary care physicians (in particular, family docs). We spend more per capita on health care than any other country in the world, and what do we have to show for it? Bupkis!

A couple of decades ago there was a miniseries on Masterpiece Theater about a British G.P. at the turn of the century (the other turn-of-the-century) who became frustrated treating an epidemic of dysentery in his small town and one night blew up the well that was the source of the problem.

For a long time I’ve been advocating something similar for the US health system. Blow it up. Sure, some people will be hurt, but collateral damage is unavoidable to get us to a more rational, patient-centered system. I’m not sure how hurting people is patient-centered, but you can’t deny the visceral pleasure in blowing things up (rent Tropic Thunder for details).

This Christmas I suggested to my brother that he buy me Sen. Tom Daschle book, “Critical — What We Can Do about the Health-Care Crisis”. He’s always complaining about how hard I am to buy for, so I thought this would give him a break. My thinking was if Daschle is going to be the new health czar and he actually wrote a book about his plan for health reform, it may be worth the read. It was.

I’m not going to discuss his plan, but he got me thinking about the “sausage making”. Now, before Daschle lost his reelection bid, he was Senate majority leader. My guess is you don’t become Senate majority leader without knowing a little bit of deal making. His theses are that the conditions are ripe for major change and that we should not allow the perfect to get in the way of the good.

So I’ve changed my metaphor. Are we going to break a few eggs to make an omelet or are we going to rummage through the refrigerator and assemble the unspoiled leftovers into a feast? I might be able to make a perfect omelet, but that leftover HoneyBaked Ham is looking mighty tempting.

Your comments are invited. (All published comments are peer reviewed.)

For more on the Twentieth National Conference, see: Twentieth National Conference on Primary Health Care Access in Monterey