As leader of the Nebraska Chapter of the American College of Physicians as well as a teacher and practitioner of internal medicine, I fear for the future of health care in America if reform efforts fail again.

The current bills being considered by congress are long and complex. Those against reform pick out specific aspects of the bills such as the public option or end-of-life counseling and urge congress to defeat the entire package. In reality, such attacks shift the focus away from the current crisis.

The fact is that our health care system is in crisis. To do nothing will lead to dire consequences that I fear will be worse than any downsides the legislation may have.

Many say they like the way the system is now. They may not realize that Medicare Part A will run out of money by 2017. For those not on Medicare, it is estimated that by 2017, an average family of four will spend 40 percent of its income on health care. This is not the America I want for my children.

My recent professional experience puts a very human face on the crisis. Never in the 23 years that I have been practicing internal medicine have I seen so many patients without health insurance.

I endeavor to practice medicine without regard for patients' insurance status, but I am increasingly stymied by the inability of my patients to obtain prescription medications, diagnostic tests and needed medical procedures because of their lack of coverage.

When they get sick enough, they can go to the emergency department. Existing law mandates that they be treated without regard to the ability to pay. Their treatment is much more expensive than if they could have afforded the appropriate care in the first place.

When such patients get their medical bills, they often face bankruptcy. Because the health care providers rarely get paid for such care, the cost is shifted to the increasingly smaller number of patients who actually have insurance.

To make matters worse, after uninsured patients are stabilized, they often remain in the hospital for an extended period of time receiving care that would not normally require continued hospitalization. The reason they stay is that home care agencies and nursing homes refuse to take patients who do not have a means to pay. I even had a home hospice refuse to take a terminally ill patient because of a lack of funds. He will most likely be stuck in the hospital until he dies. Situations such as these break my heart.

We can and should do better. We must provide access to affordable health insurance for all Americans. Health plans must be prohibited from turning down, canceling or charging exorbitant rates for patients who have pre-existing conditions.

To eliminate the cost shifting of care for the uninsured, individuals should be required to buy coverage once affordable options are available.

We must change the flawed payment system that encourages more procedures rather than better outcomes.

We must create incentives to reverse the catastrophic shortage of tens of thousands of primary care physicians.

Medicare and Medicaid payments to primary care physicians must be made competitive with other fields and should provide payment for comprehensive, preventive and quality care.

The current legislation contains hundreds of provisions that address the needs I have outlined above. Let's not let the controversies over a few of these provisions destroy what may be our last hope for meaningful health care reform for the foreseeable future. Urge our Nebraska congressional delegation to work toward a solution to the controversies so that meaningful legislation can be passed. We cannot afford to leave the system the way it is.

Thomas G. Tape, MD, is governor of the Nebraska chapter of the American College of Physicians. He also is a professor and chief of general internal medicine at the University of Nebraska College of Medicine.