In this year of health care reform, it may seem a bit odd that we are publishing two articles on helping uninsured patients get the care they need (see “What You Can Do to Help Your Uninsured Patients," and “Offering Financial Assistance to Newly Uninsured Patients"). After all, if the uninsured all end up covered, their big problem will be finding doctors with enough time in their day to see them, not finding money to pay for care.

At the risk of sounding overly pessimistic or even outright cynical, I have to say that I'm afraid there's good reason to publish these articles now. As I write (during the August congressional recess), there seems to be a fair chance that significant health care reform will be shouted down and heckled off the stage. The forces arrayed against reform are powerful and well-entrenched. The insurance industry is working hard to stave off competition from a public option. The condition of the economy has people especially nervous about making any big changes now, not to mention changes that may have massive price tags. No, much as I'd like to think that our articles on helping the uninsured would be obsolescent as they're published, it's pretty likely that you'll find them as useful next year as this. The uninsured we may have always with us.

That saddens me. I'm actually enough of an idealist that I've been rooting for reform, partly on behalf of the uninsured and partly on behalf of the embattled family physician. The possibility of a public option that might actually force the commercial payers into behaving with decency, the moves toward redressing the imbalance between primary care and specialty care payments, the various ideas for Medicare payment reform that would make the annual sustainable-growth-rate crisis a thing of the past – I'd hate to lose these if reform hits an iceberg.

Like you, I'll be interested in following the debate this fall. The idealist in me will keep his fingers crossed and think about what your practice would be like, and what FPM would be like, if you didn't have to worry so much about staying solvent; the pessimist will continue working on helping you to survive and take the best possible care of your patients in a broken and chaotic health care nonsystem.