By Evan Falchuk

Some people are upset or wringing their hands about this bufoonish speech by little-known representative Alan Grayson from Florida.  All of them – including Grayson – are taking themselves way too seriously.

And they – like reformers and their opponents – are missing what’s important in health care.  They’re all fixated – as they have been from the beginning – on who pays for health care, and how.  It’s a problem that long pre-dates this latest reform effort.  Its impact was well documented in Atul Gawande’s (thoroughly misunderstood) article in the New Yorker.

Gawande showed how our fixation in America on money — rather than medicine — was creating the very problems we are trying to solve.  Money has become the central organizing principle of our system and efforts to reform it.  And so as reformers focus on ever more clever ways to pay for medical care, they continue to systematically undervalue everything that makes for high quality medicine. Things like time with your patient, thinking about his or her problems, consulting with colleagues, and coming up with sound advice.

So the focus on a “public plan” or the arcana of insurance underwriting completely misses the mark.

Your care may be paid for by a private insurer or a public one.  Your coverage may be called a “Cadillac” plan or a high deductible plan.  You may be uninsured.  But there are some things that will be virtually certain if you get sick regardless of who and pays for your care and how:

The majority of your medical visits are going to feature face-to-face contact with your doctor of 15 minutes or less.  Your care is going to be fragmented, with information about you stored in paper files, electronic records, and the memories of the doctors you have seen.   You’re going to be on your own, facing important decisions, with too few places to turn to for help.

It’s bad, and in my experience, almost everyone I talk to on this subject has some personal experience with health care that looks just like this.

What’s even more troubling is what happens to many of them.

Studies show that 15% or more of patients have their diagnosis missed, delayed or wrong. Others have found that the biggest driver of this poor quality are the cognitive errors that happen when you make complicated decisions with fragmented information and restricted time.  Our own data at Best Doctors show that more than half of patients end up with the wrong treatment.

It’s not clear if the current effort to focus on money over medicine will succeed or not.  But for those who have become engaged in health care because of it, there is an opportunity to lead a renewal of thinking about health care in America.  We need to refocus on what is really important when you’re sick.  That your doctor is able to spend the time with you that you need.  That he or she is able to think about you, answer your questions, help you understand your condition.  That you are sure you have the right diagnosis and treatment, and the best chance to get well.

UPDATE: Dr. Bob Centor, who does some of the best blogging on this kind of ‘re-thinking’ of health care has a post up on this point that’s well worth reading.