As you have probably heard, starting in October 2008, Medicare will no longer "enable" US hospitals to make the many medical errors that have become synonymous with a hospital stay. Among the errors no longer reimbursable will be treatment of catheter-associated infections, which usually signal lack of adherence to the prevention guidelines—a practice that is more common than one cares to admit, as discussed in this issue.

So while the Centers for Medicare & Medicaid Services (CMS) is finally getting ready to limit some improper medicine, it still has not heeded the call to reimburse physicians for using appropriate and necessary prevention therapies (see last month's issue of IMWR).

This confirms Dr King's insightful argument that "poor-quality medicine is being rewarded; high-quality medicine is being punished" (Letters, this issue). His example of a Medicare insurance carrier's refusal to pay for outpatient treatment of his elderly patients (aged 72-102), but "we will be happy to pay you if you simply put your patients in the hospital and start a line in them" could have come directly out of Michael Moore's Sicko (that high-school educated man who seems to have put our ailing healthcare system on the map).

And Dr King continues, "In contrast, the insurance carrier pays off like a slot machine if a resident in a teaching hospital does a procedure in a demented, terminally ill patient with virtually no hope for reasonable quality of life. Imagine the costs to the carrier."

Nevertheless, and at the risk of being labeled "naïve" once more (see this and last month's Letters), CMS' new ruling seems to have lit a fire under the issue of healthcare reform.

On August 23, 2007, the AMA has finally jumped on the need-to-insure-the-uninsured wagon, by issuing its first statement about the 47 million uninsured Americans: "Today's announcement on the increase in the number of uninsured Americans is a forceful reminder that action is desperately needed. Currently, 47 million Americans, including nearly nine million children, don't have health insurance coverage. It is unconscionable that the number of uninsured children has substantially increased over the past year. Children are our future, and for kids to get a good start in life, they need access to regular visits to the doctor."

But the "47 million uninsured Americans" has been discussed by many for almost a year—so why now? (Should we thank Mr Moore or Medicare for this belated awakening?) And was the "45 million" uninsured, so frequently reported for at least 2 years, less significant?

And speaking of "millions" and "slot machines"—in its statement, the AMA has announced it has launched a "three-year, multi-million dollar campaign called Voice For The Uninsured to spur action to cover the uninsured." Who exactly is this ad campaign targeting by advertising in the New York Times and USA Today?

The AMA says, it "is reaching out to voters and candidates to talk about the problem and the AMA's solution….Under the AMA proposal, the vast majority of Americans would have the means to purchase health care coverage. It would give individuals choices…and would promote market reforms in the insurance industry." Does the AMA really think it has to spend millions to convince Americans about the need to reform our healthcare system?

It is time for Americans to unite outside of politics and demand a total reform of healthcare, not just "market reforms in the insurance industry." This is just more of the same, with a different tune.

It's naïve to think that the status quo could remain for much longer. But it's not just primary care; American healthcare as a whole is dying. The business model is not the right model for healthcare. Medicine is. It won't be easy or quick, and it will mean some type of "Medicare for All," as Dr Hacker so aptly said in his recent editorial (N Engl J Med. 2007;357:733-735).

Dalia Buffery, Group Editor