The Allegheny County Medical Society supports the spirit of Gov. Ed Rendell's "Prescription for Pennsylvania," which is designed to increase access to competent, quality health care. As a body of physicians, the medical society advocates for the best interests of all patients and encourages reforms to improve the quality, safety and affordability of medical treatment in our commonwealth. Therefore, in navigating the governor's extensive proposal, we do so with patient care as our compass.

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The effort to "Cover All Pennsylvanians" by offering affordable health plans to uninsured adults hopefully would provide greater access to medical care. Although Mr. Rendell's plan is drawing criticism from those who support a "single-payer" system which would have the government collect and distribute payments for health care, the governor's proposal no doubt recognizes the tremendous void in health-care coverage and works to fill that need. Certainly, the role of the medical-insurance industry in health-care reform should be open for evaluation and discussion. However, simply criticizing insurers is not as productive as including them in the reform dialogue that will lead us to a system more closely aligned with patients' needs in today's economy.

Reforms to the state's health-care system that address cost should include measures to streamline the business process of practicing medicine. Every year billions of dollars are spent on health-care administration, increasing the cost of health care. Physicians are forced by a bulky business system to spend less time on patient care and more time sorting through insurance demands and government regulations. A plan to promote efficient management of medical information would in the long term reduce medical errors and cost.

The governor's recommendation that hospitals invest in medical technology, such as electronic prescribing tools, to decrease medical errors is a commendable start in addressing the administrative issues that impede patient care. Nonetheless, many physicians, especially those in private practice, would have difficulty purchasing and integrating these expensive systems, a consideration that a comprehensive health-care reform plan must address.

Gov. Rendell's plan includes many initiatives that would have a direct impact on patient care and that already have been receiving attention locally. Through the Pittsburgh Regional Health Initiative, health-care stakeholders have worked on developing and sharing best practices in reducing hospital-acquired infections. Moreover, the Allegheny County Medical Society has long promoted healthy living and recognized the responsibility of the individual in his or her own health and lifestyle choices. Smoking cessation, nutrition and exercise are all crucial components to a healthier community.

Addressing the challenges faced by overburdened hospital emergency rooms, the governor's plan suggests redirecting certain patients to non-urgent health clinics. Such care would be provided by nurse practitioners, physicians' assistants and other licensed health care providers. Certainly, the team approach to health care could prove to be efficient in terms of patient care. However, as physicians, we must be assured that patients receive the best and most appropriate care and that all health care providers are working within the extent of his or her training. With privilege comes responsibility, and the state will have a responsibility to assure that all medical professionals are well trained, current in their knowledge and have appropriate supervision available when needed.

		Dr. Krishnan A. Gopal is president of the Allegheny County Medical Society (gopal@acms.org).

In addition, the plan asserts that at some undefined point in the future the state would refuse to pay hospitals for furnishing treatment that the government deems unnecessary. We must proceed with caution in determining appropriateness of care. Who will absorb the cost of providing treatment that the state later rules to be unnecessary -- or the cost of liability when a patient suffers consequences from being denied treatment?

The Allegheny County Medical Society commends the governor for taking the initiative in recognizing the need for access to medical care for all Pennsylvania citizens and addressing the complexities of health-care reform. We look forward to participating fully in the "Prescription for Pennsylvania." Every resident of the commonwealth has a critical stake in the future of health care. Therefore, we must make certain that our leaders in government understand the issues thoroughly and make well-informed, wise decisions.