As the country celebrates our independence from Britain I look about and see how many of our freedoms we have relinquished in favor of big goverment. While I do believe in helping others it seems almost Orwellian to watch the monster grow, knowing that the food will be tax dollars. One of the biggest consumers of the tax dollar base is health care. Already the medical aspect of life makes up 9-11% of the gross national product, and it looks to soar as the baby-boomers age.

People are fed up with high prices of medicines, high copays for tests, hospital costs, etc. President Obama wants to overhaul our health care system and many are jumping on board without thought of all of what this will entail. The American medical model cannot continue with impunity. And gauging at the 'success' of Medicare and Tricare insurance models, trust me, no one wants our health care all government run either.

Regardless of how it manifests, there exist two requirements of people for it to work: self-responsibility and embracing the end of life.

One of my mentors, Dr. Jim Lulek, is a surgeon in Dearborn, MI. Fine man, excellent surgeon, the doctor that all the who's who would go see. He was sued and lost in a breast cancer case. The woman's biopsy was negative, but Dr. Lulek insisted that she return for close follow up--she didn't. Several certified letters--signed by the woman--were sent and still no return visit. You guessed it. Three years later she developed cancer. She sued and he lost. Basically because he didn't pick her up at the house for a follow up. As an intern I quivered at the thought of people being so malicious. Idiotic cases such as this are why physicians pay $10,000 to $75,000 a year for malpractice coverage. And the kicker is as a doctor you can't 'play' without it. Don't have coverage you can't be part of a hospital. Not part of a hospital you can't be on health insurance plans. It's a real catch 22. Yet, look beyond this case and you will see the element overlooked by the jury: self responsibility.

As a physician I can only coach people on what to do with their health and their lifestyle as it affects their health. Beyond the magical domain of my office I am powerless save the rare times I catch the diabetic at IHOP ordering pancakes.

If the letter of the law says I have to be responsible for people's actions outside the office, then let me claim each and everyone of them as a dependent on my tax form. To paraphrase a great man, ask not what Mr. Obama can do for you, but what you can do for yourself!! Of course there is diet, exercise, limit alcohol and quit smoking. But what good is that if you are all stressed out?? Stress kills!! It increases one's blood pressure, blood sugar, serum cortisol levels, blah, blah, blah. Bottomline, it shorten's your lifespan. Be sure to take part in an activity that reduces stress. Encourage your congressional representatives to not only have insurance that covers preventative testing but also to have massage, accupuncture, energy work to have partial coverage if not 100% coverage.

Switching gears here, of all the health care dollars spent on an individual, 70+ percent is in the last three months of life. Face it folks, none of us make it out of here alive. To be sure we physicians have not helped this along. It is not that we think we are gods, but during residency there is a question and answer period called morbidity and mortality rounds. Ooooo Mufasa--they were/are scary. During this time the intern or resident that last touched the patient is torn apart piece by piece. Geez I cringe at those memories! "Laing, why did you let the patient die!!" As if I can control the world!! Hell I couldn't stop my son from farting in public back then, how in the world could I become omnipotent and stop death?? Nonetheless, like Pavlov's dog, a young doctor learns the creed and follows it dilligently: keep em alive til five.

This week I had a patient make a comment to me that kind of hit home: White people don't take care of their elderly like Asians, Hispanics and Blacks. Painting everyone with the same brush seems a little harsh, but perhaps a ring of truth?? Perhaps because causcasians are more affluent? Whether we are guilty of that or not the fact remains that we as a society have more fanfare for the hellos (births) than the goodbyes (deaths). I strongly encourage everyone to make more use of home hospice. Whether hospital based or home based the care given by hospice nurses is truly nurturing to the patient and to the family. Not to mention it is also a lot less expensive. Who knows, maybe if we took the end of life more seriously, we might see a decrease in violence in society as a whole. Grandiose thinking, but one can hope.

So, there you have it. A physician in the trench's viewpoint on how to help bring this ship out of its nosedive. Hilary didn't want to listen to physicians when she tried. Hopefully Mr. Obama will.