This is a great article, despite the fact that your politics doesn't exactly match mine. Although Mom forced me to vote for Obama, using a modified version of the 500 mile rule.  That is we cannot have sex if any of the children are within 500 miles of us.  The modification was that I also have to vote the way she does, particularly when my three kids are also voting the same way.

Anyway, the article is beautifully and reasonably written and I am proud to say you are my son the "Big Doctor".

Luv Ya - Dad

While I enjoyed and agreed with many parts of your article, I grow weary of the self-appointed intellectual elite calling others who happen to disagree morons. I am by no means an idiot or moron. In fact I possess an IQ of 135. I was not in a position to attend an "elite" university where I could be taught how much better I am than those lowly serfs who attended a state school.

In my 30 years of voting, I've never registered as anything other than Independent because I choose to vote for the person not the party. I research candidates positions and records on the issues rather than party affiliation or whether or not they obtained an Ivy League education.

Why does no one ever point out how poorly Medicaid serves the public? Have you investigated the Self-Administered Drug legislation or seen how it is effecting patients? Medicaid will not pay for these SAD drugs when given in an outpatient setting including Emergency Rooms but will not allow us to give them to patients for free. I've seen event reports where patients have refused premedications because they don't want to pay for them who have then had allergic reactions. Or the hoops we must jump through to document start and stop times of IV medications even if it is a few seconds to push morphine so that Medicare will pay for the charges. Who implements these rules which reduce reimbursement first? Medicare does, then other insurance companies follow. Insurance reform is great but clean the government house too.

A minor adjustment to your topic:  "How Health Care Reform Would Have Changed the Hospitalist Field...And Vice Versa."

All of the major issues are still in play:  the near-term insolvency of Medicare, the vast millions of Americans without insurance, the need to bring primary care back to the foreground, medical malpractice, medical student debt, Dartmouth Atlas vs. McAllen, Texas, the moral hazard problem of going without insurance vs. the legality of an individual mandate to purchase said insurance, health care cost inflation, and so on.

(Maybe you could spend the hour just LISTING the issues involved.)

Because all of the above issues still need to be address, the next legislative crack at a comprehensive solution (however far away that may be) is likely to be similar in structure; it simply will have become mission-critical for national solvency to pass legislation by then, rather than the mere urgent pressing need it was in 2010.

Alternatively, we could all submit jokes for presentation.  I've got one along the same lines of "breaking bad news":

Two brothers took some time off from their jobs to pay an extended visit to their mother, an elderly woman in failing health.  The older brother brought with him a most cherished pet, a cat that he had had for over ten years.  A few days into the visit, this older brother, an upper-level executive in his company, learned of a crisis that demanded his presence back at work for several days.

Before leaving, the older brother asked the younger brother to look after his cat, giving precise instructions on feeding and other issues.  Unfortunately, soon after the older brother's departure, the cat escaped outside through an open door, ran into the street, and was fatally hit by a car.

The younger brother realized he couldn't flat out tell his older brother about the incident; he loved the cat so much that the news could be devastating if delivered the wrong way.  After some thought, he came up with a way to gradually break the news.

The next day, the older brother called, asking after the cat.  The younger brother said, "Well, the cat got outside.  She's up on the roof and we can't get her down."  He promised he would call the fire department if the cat didn't come down by herself.

The following day, the older brother called again.  The younger brother said, "The cat tried to jump down by herself, but she ended up breaking her leg.  We're taking her to the vet."

The older brother called again the next day, asking for the latest information.  Empathetically, the younger brother informed him that the injuries were too severe, and that she passed away at the vet's office.

The older brother became very emotional, was able to accept what had happened.  "Thanks for doing everything possible to help my cat.  By the way, how is Mom doing?"

"Mom?  Well, she's up on the roof and we can't get her down."

The one time I took an IQ test it indicated I was in the top 7/10th of a percent of intelligence. As such, I suppose I could also refer to anyone I happened to disagree with as a "moron". However, I don't choose to do so. My intelligence tells me that to do so is to come off as arrogant and coarse. It also tells me that it is those who lack the ability to refute an argument that must resort to personal attacks and insults.

You also need to look more closely at the financial underpinnings of these bills. They were a collection of budget gimmicks designed to create an illusion of being affordable.

I often remark to patients who put off thier colonoscopy that denial is a workable health care strategy. It works right up to the very end.

Your position as a thought leader is undermined when you insist on denying what occurred last week in Massachusettes. Yes , the elitists are smarter than most Americans. They scored well in the big tests for academic advancement and we benefit greatly from thier hard work and discoveries,etc. Unfortunately , they are not the whole fabric of what we call the American experience. As a matter of definition, they need to be a minority, hence elite. We should all respect the minority opinion of the elitists. By respect I mean to say "listen to understand" rather than the "listen to respond". The ability of the elitists to lead will require a message that captures the hearts and minds of the majoriity of Americans who sometime have a hard time understanding the big words and difficult concepts of Life , Liberty , and the Pursuit of Happiness. Teabaggers and morons abound! Maybe the lesson from Massachusettes is listening to understand. The failure of Air America was not in its message. It was in its cynicism of dissenting opinion.

The opportunity is clear. You can be a thought leader or a thoughtful one. Choose wisely.

The following comment comes from Bob Centor, Associate Dean at the University of Alabama (and author of an excellent blog, at http://www.medrants.com/ )  Apparently my site wasn't accepting his comment (as you see from some of the above, it isn't because I'm blocking comments that don't agree with my point of view!) -- we're working on the technical glitch, but in the meantime, here, with Dr. Centor's permission, is his comment:

Bob,

While I agree that we need health care reform and that the bills were acceptable, I would argue that they are not good. The Democrats have done a miserable job of "making sausage" and of explaining their bills. They have not acted quickly enough, and they have not had discipline.

The result are 2 bills (House and Senate) that one could describe as large Xmas trees with many broken branches and ornaments. This makes it too easy to criticize the bills. Critics can avoid the strengths of the bills and highlight weaknesses.

Massachusetts shows that all politics are local. The Democrats had a weak candidate and the Republican ran without ever using the label, rather claiming the independent label. He successfully focused on the weaknesses in the bill and in the administration's approach to terrorism.

The Democrats unfortunately do not understand how to develop a "sticky message" about health care (see Chip and Dan Heath's great book - Made to Stick), rather they suffer the Curse of Knowledge.

If I were you, I would focus on how Hospital Medicine can improve health care, and would highlight the safety movement - root cause analysis and checklists. I would talk about the dangers of transitions.

Good luck.