that we need to do? there are ways to fix that, just like to call on other people to help you. there are modules that you could take in your next cme about pain management and other issues. it is not enough to talk only about more money and only reaching out to the medical students. that is just not going to get it done. >> you could not be more right. we do talk a lot about the pipeline, but every physician is expected to learn new stuff throughout the course of our careers. we all do that. all 24 specialties within the abms boards require periodic recertification to show that you have been keeping up with your knowledge. we have a tool now where we could begin to offer that kind of education and also measure it

and hold positions accountable and recognize them and actually recognize them when they achieve it. so i think that your point is very well taken. you should be aware that some good news on the horizon, we've been talking about all the problems out there, is that 10 different specialties got together to create a subspecialty certificate. diane was very involved in this, in hospice and palliative medicine. medicine. so there now are board-certified specialist in this area, and notches in the primary care arena but in several different surgical specialties, in psychiatry, in neurology, in pediatrics as well. so the fact that there is no kind of a recognized way of saying this person actually has these skills should allow us going forward to be able, and maybe even have, you know, educate consumers, especially family members, ask these kind

of questions. you know, do you have a specialist in this area, or do u have expertise in palliative medicine. learn that term, and ask people about it. that will begin to make a difference to. >> well, i appreciate your comment, gail, but i have to say this. someone who is work and the fee-for-service medical sector for over 30 years who has been basically at the mercy of whatever medicare, cms, decides every year what my services are worth, i have to tell you this when you talk about, let's not talk about more money in the system. and i'm not talking about that either. i would like to see them shift some money in a system that when an air nose and throat doctor gets more money for cleaning blocks out of my patience here because that is a surgical procedure, then i get from a 90 year-old woman comes into me and tells me she has had a little spell and i have to use my time, my diagnostic skills to try and

figure out is a serious, does she need to go to the hospital, do i need to do some tests in the office, what can i get away with with this woman and it might take me an hour. and somebody cleans wives out of an ear and gets more money. i would say there is a problem with the system. and in my estimation, and i talked about medicare being flawed system. it is very flawed, but it is fixable. it is fixable. if someone will sit down with doctors who have been doing this for a while and say, you know, how would you fix this? is it right that an mri scan is reimbursed at $1200, but you get, but dr. winakur, you get a $60 when a patient comes in with a little spell? well, i say yes, we don't need more money in the system, but we need to reallocate what is in the system. >> all right. as we wind our way to a close, i want to do a slightly different version of what i did with the earlier panel where i asked the earlier panel to speak to their

elderly parents. i'm going to turn things around and ask you to speak to your children or grandchildren. and i know chris in particular has a very smart 13 are sold year-old grandchildren i want you you to imagine infinite you a couple really sharp 12 and 13-year-olds who are your grandchildren or your children, and i want you to tell them what your hopes are for the health care reform debate that we are having in this country. and in particular, with respect to these issues. now these of course are going to be 12 and 13 euros. they are not prepared to think about death or dying, but they perhaps are smart enough to know that they too will get there someday, or they certainly sensed that their parents or their grandparents will. so you have 30 seconds of their attention because they are about to go play on the wii or something else like that. >> what a great question, susan. well, what i would say is if you

are right, not to talk about death, but most importantly, this gets to the topic of the whole session today, is that my hope for her would be to live in a country where she didn't have to worry about going broke because of health care expenses herself personally. that she could live her life and be confident that there would be some reasonable approach to providing medical care for her parents, for me, and for her, should she need it that would be affordable. and that she could actually be reasonably confident that it would be good quality care. and so that, that would be the main thing. what i would also say, getting to jerry's important point, is that i have been trying to entice her into going into medicine, of course.

and what i would say to her is, and it would be a system that would provide you a very personally rewarding career as a physician, knowing that you could help people in the ways that made sense. >> diane? >> well, i have a 23 year old and a 20 year old. and what i would say, what i do say to them is that i am working for a time so that when they are my age there will be no debates about health reform. everybody who is born an american citizen will know that they have access to high quality medical care, just as they know if they put a letter in a mailbox it will arrive. that is not true in many countries of the world. that the postal system works. we take it totally for granted. i want a health care system like the postal system, that people can take for granted, that it works quite well. is consistent. it is standardized across the

country. that people will get the care they can benefit from and the care they need, no matter where they are, no matter who they are, no matter what color they are, what no matter what their income is. that that is what i am working for so that my kids and their kids will inherit that kind of system. >> jerry, the last word to you. >> i have two daughters who we call doctors. one has a degree in redish romantic poetry. [laughter] >> and the other is about to earn her doctorate in counseling psychology. why they did not choose to go into medicine, i think, well, we touched on some of those issues today. but what i want to tell betsy and emily is that your father has written down and you know where it is what he wants when it is his time. and i encourage you to, at some

point in your lives, have this conversation among your own family and write it down. >> and on that note, we will bring this to a close. i want to once again say that health affairs really is so grateful to the organizations that made his forum possible today. the robert johnson foundation, the association of american medical colleges, the american board of internal medicine, and the american hospitals association. we pledged to bring you a serious discussion that was at the level that the topic demands, a serious health reform as we said demands a serious discussion. i hope in the process we have also brought you one that you have found provocative, stimulating, informative, and as we heard from the last panel, even emotional. thank you very much for coming today. please take a look at our

website, thank you to this panel and our previous panels. have a good day. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> we, as a nation, with great privilege are embarking on a great debate. i have yet to speak to many americans who think we cannot do health care better. the overriding input i have received to date is that if we do nothing, we, as a nation, elderly, young, men, women,

rural, and urban will suffer greatly. we have seen that. the great question is, what do we do? how do we build enough consensus so that what occurs is something that we all have a bite in for -- buy in for? it has given me great heartache because many people on both sides have said things about this bill better simply not true. -- on this bill that are simply not true. if i had to vote today on this document, i would not vote for it. [applause] that is not for many of the reasons you hear about in the

mass media. some of those reasons need to be dispelled. there is nothing in this bill about abortion. in fact, federal money, by federal law, cannot be used for abortions period. it is federal law. those who read this bill and develop great emotions should understand that. there are other things to be concerned about. i got an e-mail that was all in. they said on page 25, there was mandatory euthanasia. do not laugh. it is a very serious issue. how many have seen that e-mail? it has been going all over. let me do something here. it is not easy reading. it really is not.

it is not because it is a law. it is written by lawyers. it has to be very, very precise. the comment was that we should fix that. i am not sure that i do not want laws that are very specifically written. i want lawyers to be able to compose documents that will withstand the test of a trial by jury, what ever it is. it is incumbent on me to do my homework, to read this. it is supposed to be difficult. it is not supposed to be a walk in a park, even though we are in a park. let me read this one paragraph. i am going to use of water from time to time. -- i am going to get a sip of water from time to time. >> can we ask questions soon?

>> in about five minutes. i'm going to set a couple parameters and then i will answer questions. as an example of a lot of things that are distracting us from the true things that must be debated about health care, it has been said that this bill contains mandatory euthanasia counseling. this is what it says. "under medicare programs, an explanation by the practitioner of the continuum of end of life services and support available, including palliative care and hospice, and benefits of such service must be made available upon request." that is a big difference. [applause] to answer the question of why that would be in their, we learned that the hard way. hospital administrators and doctors came and said this must be in their because we have far

too many americans go a arrive at a situation where they cannot speak for themselves in medical situations. therefore, the doctors, hospitals, and families are caught in a trap. therefore, upon request, those services should be available. that is a far cry from what i read on the internet. >> as congress continues its summer recess, we would like to hear from you. are you attending a town hall meeting in your community? what do you think about the various proposals being debated? share your experiences and thoughts with us on video. >> tomorrow, a political roundtable where they talk about the health care debate and politics heading into the 2010 midterm elec