President Obama has mentioned many times that the health reforms he is proposing will not alter the health care of those who already have health insurance and want to keep what they have. But this is NOT the view of most practicing physicians — myself included. I may be one of the most vocal, but I am not alone.

1.  First of all, there is a critical and growing shortage of primary care physicians. Only about 2 percent of the current medical school graduating class is going into primary care. Those of us who already practice primary care are overwhelmed and many are quitting. The public insurances have the most trouble. Surveys show that 50 percent of doctors don’t take Medicaid, and in 2008, the Medicare Payment Advisory Commission found that 28 percent of Medicare patients looking for a primary care physician couldn’t find one. This problem will only get worse under any Obama plan. You may have new government-provided insurance, but you may not be able to find the doctors who take it. And if you do, they may be buried under a pile of paperwork, or be too busy changing over to the new Electronic Medical Records system to spend time with you.

2.  More than 150 million Americans have employer-provided health insurance. But if there is a public option, your employer may stop providing you with insurance. You may be compelled to take the public option, which will probably provide you with less real health care choices.

3.  If the public option grows bigger, because private insurers find they can’t compete, expect care to be rationed, as the government makes choices to try to contain costs. Reimbursements to doctors will be cut, as they have been under Medicare and Medicaid, but also, you may not be able to get dialysis if you are over a certain age, or you may have to wait on long lines for procedures, as they do in Canada.

4.  Bottom line — extending a system that already has too few primary care doctors who are overworked to the entire population does not bode well for prevention or quality of medical care. The costs will continue to spiral upward, and access will decrease rather than increase. A better approach would be to work on re-organizing the health care system towards prevention rather than intervention BEFORE expanding it. One way would be to pay for the education of primary care doctors and create a task force to treat the uninsured.

For more on my take on public health insurance and how doctors view it, check out my oped in Monday’s NY Post.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

These are interesting times we’re in ― to say the least. Over the past couple of weeks, we have all been concentrating on “Octomom” from California, and with new developments in the story everyday, it’s easy to see why she’s been the topic of conversation. I was following the story too, calling for an ethical investigation of the fertility clinic from day one, but with the state of our economy and the country experiencing what could be one of the most pivotal moments in American history, I want to move past that story.

I think it’s time the media starts concentrating on the changes that the Obama administration will be proposing in the future and some of the ideas that have already been approved.

Now, let’s look at the facts … The American health care system needs help! Why? Well, because it is filled with inefficiencies and overpriced operational costs.

How did it get like that? Well, it’s possible the American health care system has seen a lot of the same issues as our financial sector ― which we all know by now is quite a mess. Our financial experts have given us many explanations for the current economic crisis: Many blame the banks for recklessly handing out loans and credit, some blame the public for borrowing more money than they could ever repay, then there’s all the greedy Wall Street executives making profits off back of funds that don’t even exist, and who can forget those elaborate Ponzi schemes that went unnoticed by federal agencies for years.

Well, believe it or not, we have a lot of the same things happening in health care. We have some patients that demand every test in the book on the basis of what they’ve read or seen on television, hospitals that have been enamored with demands because of technological advances and profit margins, and doctors that have concentrated on sub-specialty service, rather than primary care and prevention.

So now, we are all looking to President Obama’s stimulus bill to see how he will resolve these problems. Some of his proposed ideas are very interesting. Electronic medical records, for instance, provide us with computerized data entry on patients, a way to track symptoms, disease processes, a way to dramatically decrease the overutilization of certain tests, minimize medical mistakes both by physicians and hospitals. And down the road, it might even decrease costs.

But many critics worry about privacy issues. I totally agree that patient confidentiality should always be protected. I remember when the new HIPPA laws came into effect under President Clinton, I could not even discuss a patient’s medical condition or get a second opinion from a colleague without getting a written consent from the patient.

But I think that before we start throwing good money in to solve the problems bad money got us into, the way previous financial stimulus plans have, we need to really understand how our current health care system is working, and address the issues that got us here in the first place.

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I am a primary care doctor. Today I saw a young woman who was afraid she might have appendicitis. I thought enough of the possibility to order a CT of the abdomen — which was negative — but I did not admit her to the hospital. She got better, and chances are the problem was due to a virus.

With primary care doctors rapidly becoming extinct, I think it is worth pointing out that if I didn’t exist, this young woman might have been admitted to the hospital for a few days, and possibly faced an unnecessary operation — at the very least it would have been a big expense to our health care system.

With only 2 percent of medical school graduating classes going into primary care medicine these days, and with 50 percent of primary care providers in a recent study saying they would quit if they could, I think it is worth considering what we could do about the shortage of well-motivated primary care doctors going forward — since we are the quarterbacks of any well-maintained health care system.

Here are some of my ideas:

• Subsidize education for primary care physicians on a state and national level with a payback of several years. As opposed to the National Health Service, which was disbanded in the 1980s, this service will inject primary care docs into urban and suburban centers with the goal of introducing a preventative strategy that can then be adopted by trained nurse practitioners and physician assistants.
• Reimbursements should favor primary care visits, and de-incentivize overuse of specialists and their procedures — especially tests (like EMG) or elective procedures (like cosmetic surgery), which do not lead to crucial treatments.
• Reimbursements (including Medicare and Medicaid) should reward preventative strategies such as weight loss and smoking cessation.
• With primary care physicians more in charge and more accessible, it might then make sense to increase insurance copays and deductibles, which would make patients hesitate before overusing their health insurance (studies show that most ER visits are currently from the insured, often for minor complaints).
• A new infusion of primary care doctors would help emphasize the principle that physicians and patients should be in charge of health care, rather than insurance companies. This could improve efficiency and decrease costs. Insurance is intended to be “just in case” rather than the primary controlling payer for all health costs. Insurance should carry over state-to-state, and insurance companies should be liable for forced medical errors — especially when they refuse to cover tests. Records should gradually be converted to electronic medical records, to improve efficiency.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth about the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com