Health-care insurance has been a constant struggle for Americans, especially for the 44 million individuals who don't have it. Now, as the government pushes for a national insurance option, the conundrum of exorbitant plans and care, insurance company fraud, and political unrest remains far from solved. Heated opinion from private insurance companies, physicians, employers, economists, and disgruntled patients continues to flood editorials, blogs, and letters to the editor.

Physicians have an important stake in the matter; any plan will deeply impact the way doctors do their jobs and meet the needs of their workplace and their patients. Not surprisingly, many doctors have a lot to say on the matter. Here's what some key players (including one PhD) are thinking.

The problem lies in the fact that many physicians have begun playing the role of businessmen, writes Atul Gawande, MD, a surgeon at Brigham and Women's Hospital, Boston, in The New Yorker. Physicians are “paid for quantity, not quality,” and this makes for a serious problem. Reform is not feasible until doctors stop thinking about revenue. Physicians should not receive a percentage of profits so there's no incentive to order extra tests and procedures with no improved outcome. Rather, they must be paid “as members of a team” on salary. Wasteful, profit-driven health care will only lead to the system in place in McAllen, Tex., where the cost of health care per person is nearly twice the national average. Mayo Clinic, the first integrated, not-for-profit group practice in the world, is a multi-site, high value, low cost clinic where patients receive abundant attention and results-focused care. This should be the model for health-care reform. (Click here to read the Texas Medical Association's response to Gawande's article).

While universal health-care access is ideal, it would prove costly and proposed measures such as reducing fraudulent billing “will only lead to marginal savings,”said Mark Sklar, MD, an endocrinologist and an Assistant Professor of Medicine at Georgetown University Hospital and George Washington University Hospital in Washington, DC, in The Wall Street Journal. Physicians would save much more by implementing medical malpractice tort reform, which includes measures such as limiting noneconomic damage awards. “The threat of malpractice litigation leads doctors to order tests that may not be critical to patients' care, resulting in billions of dollars in needless expenditures,” says Dr. Sklar. Furthermore, reimbursement to physicians cannot be cut because “levels are already too low.” To lower costs, the public should be given incentives to eat healthy and prevent chronic disease. Physicians should receive increased reimbursement for office visits, which will encourage them to spend more time with patients and lead to fewer, often expensive referrals.

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