Last week the U.S. House of Representatives passed H.R. 3962 “The Affordable Health Care Act of 2009” after months of contentious debate.

Although the idea of health care reform has created both enthusiasm and apprehension, I believe it is the right time for Congress to take this action. Our current health care (and health care payment) systems are fragmented, poorly integrated, overly technological and inefficient. Some have said simply that our health care system is “broken,” but it is not a coherent delivery system at all, and the payment systems are exceptionally complex. We are fond of saying that “America has the finest medical care in the world.” The fact is that the United States lags behind other industrialized countries in many measures of medical outcomes quality, despite having the highest medical cost in the world. It is past time for comprehensive change.

Currently, an estimated 46 million Americans do not have health insurance, a significant percentage of whom are working adults and families. Many are young adults no longer covered on family policies and not yet eligible for employer-based health insurance. Another 25 million of us do not have enough health insurance to cover our medical needs — a situation that encourages people not to access preventative and primary care services, and results in high out-of-pocket costs for care that is received. As a result, medical costs have become one of the most common causes of personal bankruptcy in recent years. I see patients every day who are affected by these issues. H.R. 3962 addresses most of these inequities.

High student debt and the current medical payment system is resulting in fewer young physicians entering family medicine and general internal medicine, and the country will soon face a shortage of primary care physicians. The Association of Medical Colleges has recently estimated that by 2025 there will be a shortage of 159,000 doctors. In Iowa, the situation is worse than in other areas of the U.S. Medicare payment is lower in Iowa than in much of the U.S. Without measures to address student debt and Medicare geographic payment inequality, Iowans even more than other Americans will face increasing difficulties with access to a physician. While not comprehensive, H.R. 3962 takes steps in the right direction on these issues.

Health care delivery and payment are enormously complex, and yet health care is intensely personal. It is understandable that reasonable people, even medical colleagues, may disagree on the best approach to improve U.S. health care systems to better serve all. The details of the bills can be confusing. The discussions of public plans versus health insurance purchasing co-ops, of insurance mandates versus economic development, of disease prevention versus treatment, of rural versus urban payment formulas, etc., have generated confusion and enormous controversy. In spite of this The American Medical Association, The American College of Physicians and many other physician and patient advocacy groups have supported H.R. 3962. It would be a misunderstanding to think that most physicians oppose health care reform efforts, when I believe the opposite is true.

In my opinion, the need for comprehensive health payment reform is urgent. We face a crisis in physician primary care workforce and shortages in other disciplines that cannot be corrected by partial measures. The health care “system” is too big, too fragmented and too important to be left to the “market” alone to fix. Federal government influence has been a major part of the health care environment at least since Medicare was passed in 1964, and bringing coherence to the system must involve a large governmental role.

The passage of the House measure moves the spotlight to the U.S Senate. I believe it is of the utmost importance to the future of medical care in Iowa and the U.S. for the Senate to take action and pass some version of health reform as soon as possible, so that a bill can be forwarded to President Obama for his signature. I believe that delay will inevitably lead to more harm. The current system is broken and unsupportable without fundamental change. Sen. Harkin supports proposed legislation in the Senate. Sen. Grassley has opposed it. Please urge both of our Iowa senators to find common ground and vote for comprehensive health care reform this year.

Peter J. Reiter, MD, FACP

Ottumwa