As we observe the current debate about Social Security raging through Main Street, Wall Street and the halls of Congress, let us not forget that Medicare will at some point be up at bat as well. In my opinion, it will be an even bigger beast to tame than Social Security. The costs of the latter may be a bit more predictable in that life expectancies can be estimated and beneficiary payments judged accordingly. With Medicare payouts, projections may not be as easy as that. Undoubtedly, as Baby Boomers grow older, they will use more medical services that are more sophisticated and possibly more costly. Let’s face it--ours is not a society where rationing of health services as a means of cost control will ever be readily accepted. We need to discuss alternative plans to allow for our nation’s obligations toward health care commitments.

One can expect that with a Medicare debate, physicians may once again end up in the line of fire. This may come in the form of reduced reimbursements to physicians, gravitation to a national health services plan, increasing pressure to employ physician extenders or new methods we have yet to deal with. Meanwhile, as physicians, we must reconcile the need to have financially stable practices, remain very efficient in our delivery of health care and assure that we deliver the finest of care in a compassionate fashion.

We are at an important crossroads in medical history. We must insist that physicians be at the table to discuss and craft solutions to this dilemma. We must be viewed as vital individuals, not key obstructions, in the cause of pursuing the answers to Medicare’s problems. The solutions will be complex, compromising and contentious. The best solutions may require new approaches to healthcare delivery that seek ways to reduce the costs of advancing technology, guarantee medical liability reform to assure as little overuse of services as possible, and ensure an honest-to-goodness discussion with Medicare recipients regarding the facts of life. Let us insist on involvement in this debate, for if we are not included, we may be simply told to go to the back room and "make the doughnuts."

Stephen E. Pascucci, MD Medical Editor [email protected]