In response to my past two ennui-ridden posts, I got several comments asking the question, what can we do? Ellen asked this:

Now that I read your blog, I once again wonder what I can do. I do believe the public is sick of the "lying sacks" - which is what my daughter calls politicians. I am sick of their lies and self-serving ways, too. If you have suggestions, please let me know. I do not believe the politicians represent their constituents - they represent themselves and those who bribe them with political contributions.

Another reader emailed me this:

So I am coming to you, with admitted ignorance about what my role is, and asking you what we as patients, consumers or recipients of Medicare/Medicaid can do to help implement solid change in the system?  I want to make a difference in the health care system and am a pretty good advocate.  Wearing the pink ribbons for breast cancer awareness is not my calling, I instead want to use this energy to advocate for real change. Any direction or advice you could offer would be greatly appreciated.

Good questions.

When I hear people saying that we need to get involved and not just sit around and gripe, I think at least I am writing about it in a forum where people actually hear about the issues. There is truth to this; blogging has offered me a great soap box to stand on that an otherwise average primary care physician would never have had.  My posts being republished on the Better Health Network, MedPage Today, and The Health Care Blog allows my voice to be heard at a level I never could have imagined.

Yet I stop when faced with questions like the ones my readers posed.  How can we turn a cry for sanity into real change?  How can we make a real difference by affecting a change in our system?  It's all fine and good to raise awareness, but being aware the boat is sinking is not the same as fixing it.

I don't really know.  The problem is that the nature of real change is a subject of much debate.  Some would say that real change must include government-run care for all.  Some would say that we should fix the tort system.  Some would say that primary care should be encouraged with better reimbursement.  Some would say that the government should stop meddling so much.  But all (except for those in total denial) would agree that our system is on the verge of collapse.

What is the common ground?  What are the nonnegotiables that are not politically polarizing?  Are there any? Or is this just a political battle, and not a battle of wisdom over folly?

So I turn the question back to my readers: can we come up with a list of non-negotiable changes that our system must have?  Can we create a healthcare (or health care, if you are that kind of person) declaration of sanity/bill of rights?

What do you think?  I really want to know what you think are the things that we could actually all agree on.  Rhetoric is fine (and I am good at it), but at some point we need to step beyond the rhetoric and actually work together.  We are asking congress to put down partisanship, yet can we do the same?  Can we do better?  Can we give a cogent and reasonable list that both Democrats and Republicans could agree on?

I want to know too.