It was the summer of 1973. I was working in emergency room x-ray in a teaching hospital in New York City. Back in those good ole days X-Ray techs had to know a lot about MA and KV, exposure time and soft tissue absorption and diffusion of X-rays. Developing x-rays required a knowledge of silver emulsions and development time. Now digital cameras make a lot of those judgments.

The word came down from on high – the top management of the hospital. From then on, all patients who came into the ER with any kind of fall were going to get a basic set of skull x-rays. What precipitated this nonsense, we wondered?

After a fall, a patient had come into the ER with a possible ankle fracture. His ankle was x-rayed. He had a sprain. He had some small skin scratches on his forehead, elbow and hand. These were cleaned and bandaged, his pupils and eye response were checked and he was discharged. A day or so later he was admitted with a brain hematoma. He sued the hospital. Under the new policy, a small child with some cuts and scratches on his knee got a set of skull x-rays. Neither the patients, doctors or staff liked the new policy. It was the dawn of defensive diagnostics. The legal department at the hospital was now making medical decisions.

Today, 36 years later, the House of Representatives passed a health care bill. You can read the jist of it here along with the 537 (and still counting) comments, some of them quite vituperative. No one has been predicting that this House version would be even close to a final version of a health care bill but it has kicked the discussion on health care reform into high gear. The Senate is working on a more moderate proposal. This bill is not about health care reform. It is about health insurance reform.

What is getting far less attention is the utter failure of the Congress to agree on real health care reform – the HOW of health care delivery and the legal environment in which health care is delivered. The Senate Committee on Health, Education, Labor and Pensions killed even a modest limited trial of tort reform, refusing to entertain the idea of special courts to try malpractice claims. Special courts for income tax cases, bankruptcy and workmen’s compensation are common in this country.

Until there is some attempt to slow the huge expense of defensive diagnostics, the ordering of tests to protect the doctor against possible lawsuits, health care costs will continue to climb at a rate far exceeding the consumer price index.

Pres. Obama is asking citizens to encourage their Senators to pass a health insurance reform bill. We need to be encouraging our Senators and Congressmen to pass a real health care reform bill, one that includes at least an attempt at tort reform.