I am in a small county hospital in Iowa, we can’t afford to buy a effective EMR in the first place, so the tax credit is of little use.

I think creating a national EMR would be an effective stimulus to the economy as well.
I see little down side but many of use need stimulus monies to implement this goal.

1. There must be a national health plan option that competes with the insurance indusry.  Otherwise we are locked into more of the same eventualities.

2. There is a need for tort reform that will settle all cases by arbitration.  These committes should include health care professionals, attorneys, business people and a patient ombudsman.

3. Somehow legislators must think beyond their next term of office.  Medicare and Social Security have had a day of reckoning coming for years.  These two subjects require ong term solutions which extend far beyond a legislators next term in office.

4. There needs to be a national generic formulary that competes with big pharma.  The VA has excellent system where nobody pays more than $1080 a year and still it saves billions of $$ compared to the private sector.

5. Something must be done to increase the number of medical students going into primary care to include internal medicine, family practice, pediatrics and gerenotology.  The single reason that the primary care option is down to 2-3% of the graduating classes is lack of remuneration.  Specialists need to be compensated less so primary care providers can by paid for the work they do.

6. Guidelines must be established as to who gets what based on realist objective outcomes.  If Medicare continues to dialize every patient that is eligible it will break the systsem by itself.  This is more important than ever because of the ageing population.

7. The issues of obesity and smoking, which aggravate hypetension, diabetes, cardiovascular disease (stroke, heart attack, peripheral vascular disease and kidney failure) must be looked at in a fresh light.  Somehow people need to be accountable for their own health

I am happy to discuss nay fo these further if someone is intereested.

Bruce Buchanan, M.D., FACP, FCCP