There has been so much in the news about health care recently, although the topics are extremely diverse and seemingly unrelated. After heavy news coverage, the question to follow is, "What, if anything, will federal and state legislatures do?"

Of great and grave interest is the federal legislation introduced to limit pain and suffering awards nationwide in malpractice cases. MICRA has been in place in California for many years, though annually there are attempts to either raise the MICRA limit of $250,000 or abolish it altogether. Some other states have imposed limits as well, but this would be the first time for federal limits. At this time, it appears that opposition in the Senate will forestall the cap legislation. (ED Note: The Senate blocked passage; both Senators Feinstein and Boxer voted Nay.)

States normally control the insurance industry, but now federal legislation has been introduced that would allow small businesses to pool resources and then offer health insurance across state lines. The coverage and benefit options would be up to the federal government and not up to the state governments as has been the tradition. In this debate, there is obviously the question of state versus federal jurisdiction.

On May 9 there was a front-page report in the San Jose Mercury News on the Santa Clara County influenza pandemic plan. The article implied that counties would be on their own, with little or no federal and state resources, to address health care needs because the entire nation/world would be affected at once. Furthermore, the severe effects could last up to two years. On May 18 and 19, San Mateo County presented its influenza pandemic planning meeting. Major hospitals, county officials, and health officers, as well as many from the SMCMA, participated.

The Call to Action – Blueprint for Prevention of Childhood Obesity – outlines nine specific issues, some of which will require county action, and the rest will require the cooperation of city governments and school boards. These include access to high-quality, healthful foods for all residents; convenient, safe access to parks and recreation facilities; vending machine policies in the schools; a push to reduce TV viewing; and education about the importance of adequate nutrition and physical activity for all people who care for and educate our children. Communities will need to allocate resources differently to achieve these goals by 2010.

A conference called "Primary Care at the Crossroads" convened in San Francisco on April 25 and 26. Several issues raised at the conference deserve political and physician attention. First, there are few medical students choosing family medicine or primary care internal medicine as a career. The major factor is the relatively lower pay of these specialties compared with surgical and medical specialties, and the gradual widening of the gap between the two groups. The major rate-setting body in the country is Medicare, and the AMA has controlled the RVU calculations through its subcommittees, comprised mainly of specialists. Over time, there is an increase in demand for primary care physicians and a reduction in supply. That can result in two different outcomes: One is an increase in reimbursement. If that is impossible because of the Medicare structure and the AMA input, the other outcome is a worsening shortage, and patients will seek care from specialists for general needs. Or worse, patients will visit emergency rooms, much in the way the uninsured do.

As part of that conference, there was discussion of states that are trying to provide universal access to care, through a primary care model. Massachusetts and Oregon are in the process of designing these systems. They both deserve careful attention because if they work, they will lead to state-by-state adoption, or to a federal program.

An active media often signals a political change. This media attention to health care may be the beginning of major political attention to true health care reform, or a series of complex laws such as the Medicare Part D, which make physician practice that much more challenging. All this remains to be seen.