I recently visited Washington, D.C., during my children's school break. In five days, we saw more tourist sites than I did during the six years I lived there. We visited the Capitol, the Newseum, the Washington Monument, the memorials to Vietnam, Abraham Lincoln, Thomas Jefferson and Franklin Delano Roosevelt, as well as a couple of the Smithsonian museums.

What my kids didn't get to see is the true business of Washington -- the behind the scenes politicking that at its best inspired our forefathers to draft landmark documents like the Declaration of Independence and Bill of Rights (which we saw at the National Archives) and at its worst, render the government powerless at fixing the country's problems.

The argument that our democratic process is broken has surfaced again and again lately in part due to Congress's inability to pass health-care legislation.

A Last Resort

So now, a year after taking office, President Obama is trying a last resort. He called on Congress last week to pass his health-care reform proposal, with a simple majority vote, which could take place this week. He pointed out that this controversial tact, known as reconciliation, was used to pass welfare reform legislation, the children's health insurance program, COBRA health coverage, and most notably, both Bush tax cuts.

Obama and congressional leaders have one last chance to convince Americans and their elected officials that this issue is above politics because the consequences are so dire. There's no question the plan is complicated and probably flawed. But the benefits have not been clearly conveyed and Americans seem convinced that passing health-care reform will make the situation worse. That's probably not possible, given that things were bad off a year ago and they're getting worse by the day.

As I pointed out in the series "Reform Health Care Now," the average cost for a small-business owner to insure a worker's family is now $12,680 -- about the same as the annual income of a minimum wage worker.

Fending for Themselves

Many businesses can no longer afford the cost of employer-sponsored health coverage so more people are fending for themselves. If you're lucky enough to find a plan you're eligible for, it's inevitably expensive and/or offers inadequate coverage.

As The New York Times recently pointed out in an article entitled The Cost of Doing Nothing, doing nothing doesn't mean things will stay the same; they will get much worse. It's a self-perpetuating cycle: The more medical costs rise, the fewer patients and employers there are who can afford insurance and the higher costs continue to spiral. And the economy has made the crisis worse. Unemployment has increased the numbers of uninsured, driving up the cost of care and coverage for everyone, which in turn, adds to the rolls of uninsured.

Haven't people noticed that each year they're paying higher deductibles and out-of-pocket expenses? Or that they're being forced to switch doctors because their physician no longer accepts their insurance plan? Maybe their doctor gave up medicine altogether because he or she got fed up with being harassed y greedy insurance companies.

Failure to Explain Consequences


Of all the Democrats' mistakes -- and there have been many -- the most egregious has been not explaining what will happen if nothing is done. For a sign of what's to come, we can look to California, where Blue Cross recently announced a 39% rate hike in individual premiums. This got lots of press, but huge rate hikes are occurring elsewhere too. American families can't afford the annual 7% rises we've seen in copayments and premiums we've seen in recent years let alone a 39% rate hike!

Little by little more of my patients seem to get it. More and more have been cutting back on health care. Every week patients who have already lost their insurance call my office to postpone appointments for minor conditions or routine checkups. This has happened for well over a year. Friends call with medical problems unrelated to my specialty and ask, "Can you look at this and tell me if I need to go see a doctor?" Patients are constantly calling and asking me to prescribe medicine without seeing them. On occasion they end up with some close calls.

As I've noticed before, delaying treatment in the early stages of an illness can end up ringing up more costs and causing unnecessary suffering. As a gynecologist, I pick up about a dozen potentially life-threatening problems a year in the course of routine screening. It could be a mole, an enlarged cyst, blood in the stool, and irregular Pap result or a breast lump. In each case when detected early, these and other comparable problems are treatable, usually on an outpatient basis with minimal costs. But if left untreated they fester and can become major costly health crises that someone -- either the patient or taxpayers-- has to pay for.

But if you're well and still have insurance, maybe none of this has hit home. It will, but by then it may be too late.

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