I am thrilled that there is bipartisan discussion about Medicare reform. Paul Ryan and Ron Wyden should be commended for their efforts. But, as big as this reform may seem, it does not transform Medicare or our healthcare delivery system. It is not the solution to the question, "How do we create a healthcare delivery system that is both affordable and accessible to all Americans?"

Moving some of the risk from the public sector to the private sector will start to take the pressure off our national debt crisis. But, like alcohol, the idea of premium support only masks the problem and is inebriating in the short run. The cost of Medicare continues to climb at an accelerating pace and will continue to do so as long as the recipients of Medicare have no "skin in the game." Moreover, no insurer or public entity can continue to pay for a benefit package that persistently grows beyond things medically necessary like the infamous and well-advertised motorized scooter (at absolutely no cost to you).

No insurer or public entity will be able to afford to take the risk of a medical insurance policy until that policy resembles insurance, an actuarial bet to protect the purchaser from financial catastrophe. Congressmen Ryan and Wyden make it clear that their legislation would insist that all competing plans be at least as comprehensive as Medicare. The cost of these competing benefit plans will be boundless and not affordable to most Americans, much like commercial insurance is today.

Americans love and deserve choice but choosing a favorite requires that there are distinguishing features. As it is, most Americans don't choose their insurance, their employers do. And when offered the choice, the plans are so confusing and incomprehensible, no ordinary American can decipher them. My patients generally ask me what to choose. I love the idea of choice but with the mandates placed on the private insurers, I'm not sure where the choice would come.

Reforming Medicare demands that Americans take back the responsibility of their own health. Freedom is NOT free. The right to self-determination with regard to medical decisions requires a transparent, market-driven system where doctors and hospitals post their prices and patients pay directly for those services that are not insurable. Preventive care, for instance is not insurable.

Preventive care includes everything from wearing a seat belt (not paid for by the government or any insurer), eating healthy food (also a personal responsibility except in the case of the very poor), to having your cholesterol checked routinely A mammogram at this time is $75.00 cash. A Chest-x-ray is $35.00 cash. A routine doctor's visit is usually less than $100. A lab test to check your cholesterol is less than $15. This is affordable healthcare that when paid for by the patient does not require a special form or an authorization making it much more available than it is even now when paid for by insurance.

I believe that most Americans do feel the moral obligation to pool our resources and take care of those who need our help. Cancer is an unforeseeable medical catastrophe that should be covered by insurance, whether public or private. But most Americans do not want to pay for their neighbor's blood pressure medication particularly when their neighbor is overweight and spends Sundays eating potato chips in front of their television. That neighbor should buy his own medication and that medication should be affordable in a transparent marketplace.

It is reasonable and wise to ask Medicare to compete with private insurers but only if we truly reform the system into a legitimate medical insurance system. At the same time, things not insurable should be able to be purchased in a transparent marketplace. If personal responsibility and the opportunity for patients to buy non-urgent medical care directly is not central to Medicare reform, we can only expect that the problems of accelerating costs and lack of access will intensify and hasten the death of what was once the best healthcare delivery system in the world.

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