Give U.S. Patients a Slice of the Pie Rather than Pie in the Sky

It's important to remember when discussing health care reform and health care policy that what we're dealing with is REAL PEOPLE'S LIVES (AND POSSIBLE DEATHS)...so I include, as often as possible, vignettes from my office practice (as always, details are omitted to protect confidentiality)...
We were seeing a patient for a serious injury today, and they also happened to mention that they were no longer taking their antidepressant. The patient had a terribly heartbreaking family loss earlier this year, and had become seriously depressed, suffering horribly as a result. I felt the severity of the depression warranted psychiatric care, but as they had no insurance, involving a mental health professional was not an option. With the aid of an antidepressant (which we initially were able to supply through free samples), the patient had begun to improve, thankfully. However, when the samples ran out, I wrote a prescription for the medication, but it turned out that the medication was too expensive. So the medication was stopped. Back to square one.
And that get's us to an article that ran in the Washington Post yesterday, "U.S. 'Not Getting What We Pay For': Many Experts Say Health-Care System Inefficient, Wasteful."
The idea is that all we have to do to reform health care is provide better quality care, using evidence-based medicine and computerized records, and the enormous savings generated will be enough to finance care for ALL. It's a popular view, especially now that Tom Daschle, one of its main proponents, has been chosen as the new H.H.S. secretary.
It's not that the idea doesn't have merit. It's that our ability to deliver, in a meaningful way, the types of changes being discussed, and the resultant savings, is a long way off.
The first step in achieving quality medical care is the ability to measure the quality of care (which is in it's infancy). To change the quality of medical care, we would need to be able to measure, in real time, the quality of most, if not all, medical care. That would take computerized records that, first of all, were capable of such measurements (most are not); and two, could pool and analyze the data (today we have hundreds, if not thousands, of types of computerized records, most of which do not communicate with one another).
It's not that this can't be done. I work with a group that has developed an impressive computerized medical record software, which is easily capable of the above.
It's that achieving this in the near future is very unlikely, and shouldn't delay other aspects of health care reform, that could help people now.
Don't get me wrong. I think that, as part of comprehensive health care reform, in addition to completely re-working our health care finance model, we should improve the quality of the care delivered, using the best evidence and technology we have at our disposal, and encourage (strongly) Americans to take better care themselves, so that we have less preventable chronic health conditions. In fact, to be really successful, I think all these things are necessary.
It's just that we can't wait for all these things, which may take a generation or more to complete, to delay immediate help for the millions who are suffering at the hands of our system currently.
The best, and most meaningful, and immediate change that we can make today, that will help millions today, is to enact single payer health care finance reform.
Real people can't wait any longer.

BE HEALTHY