Yes, Virginia, there will be healthcare reform.

More than 100 years ago, a young girl named Virginia O'Hanlon wrote a letter to Santa Claus. 1 A newspaper reporter, impressed by the girl's innocence, edi-torialized this quest to believe in a fantasy representing good in the world by penning the famous line, " Yes, Virginia, there is a Santa Claus. " This story came to mind a few weeks ago, when I was having breakfast with my daughter-in-law and she asked me what I thought about President Barack Obama's proposed health-care reform. Because I have been associated with the National Academies of Practice, a 10-profession interdisci-plinary national health policy forum, for some years, I felt well positioned to answer her question. I replied, " I do not believe that we will see universal healthcare in the United States in my lifetime. " I added, " I do not believe that the 'public option' [ie, government-run health insurance] included in some of the current proposals will be part of the legislation in its final form. " I answered as I did because I believe that our capitalist society will resist the socialist nature of the public option. Indeed, this Robin Hood–like take-from-the-rich-to-give-to-the-poor approach has met a great deal of opposition. The public option flies in the face of former President Ronald Reagan's " supply-side " economic approach— destroying financial incentives for the entrepreneurs and movers and shakers who drive our economy. My daughter-in-law responded, " That's because all you greedy doctors don't want [healthcare reform with the public option] to pass. " I then felt that I had to explain some facts to her about the current financial pressures, including declining revenues and increasing costs, faced by us " greedy doctors. " I informed her that in 1990 I received about $2000 per cataract surgery in Medicare reimbursement, but today I am reimbursed only about $500 for the same surgical procedure. Physician Medicare reimbursements have been steadily decreasing 2 —at the same time that physician costs for basic practice operations and medical malpractice premiums have been increasing. 3 I also told her that hospitals have agreed to forgo about $155 billion in reimbursement over the next several years. 4 These reimbursement reductions come as the hospital I am associated with is losing about $1 million to $4 million a month. I was quite surprised by my daughter-in-law's focus on " greedy doctors, " because she has been exposed to …