In the last few weeks, as the debate over healthcare has raged across the country, I involuntarily became a full participant in the healthcare system. My personal experiences have given me a new appreciation for the importance of having health insurance--and for the complexity of the issues at the heart of any healthcare reform effort.

A few weeks ago, after suffering unusual shortness of breath and minor chest pains, I went to the emergency room at my local hospital. My EKG and blood pressure were normal, as were my cardiac enzymes. But because I had complained of chest pains, I was told that I would have to stay overnight for observation. I assumed that I would get a stress test in the morning just to be sure, but the cardiologist on duty, looking at my history of high cholesterol (even with medication), my age (46), and the way I presented at the hospital, decided he wanted to see what was going on inside. So he opted for a more invasive-and more expensive-approach: angioplasty. I am glad the doctor made that decision, as he discovered that I had two severely blocked arteries. Within a week's time I underwent two surgeries, receiving a total of three stents. I am now on a host of new meds, have already implemented substantive lifestyle changes, and have started cardiac rehab (covered by my insurance).

As I lay in the hospital, I wondered what my experience would have been like if I didn't have good health insurance. Since all my initial tests were normal, would I have been sent home and told it was probably stress? I asked a doctor friend about this, and he suggested that might indeed have been the outcome, or perhaps I would have been told to report to a cardiac clinic in a few weeks for a stress test. I wondered if any cardiologist would have gone for the aggressive and very expensive angioplasty as the first choice if the patient was uninsured. Fortunately I did have insurance and my cardiologist made the right judgment call.

As my regular internist later observed, the cardiologist's decision to go straight to the angioplasty reflected the "art of medicine," and was facilitated by his extensive experience from treating hundreds of heart patients. It's hard to put a price tag on the knowledge and experience of outstanding physicians. Yet when insurance companies and Medicare and Medicaid heavily reduce the fees doctors charge for their work--sometimes by up to 50%--it devalues the importance of such expertise. Unlike lawyers, doctors do not bill for every increment of their professional time. Yet doctors are forced to spend an increasing amount of time each day filling out paperwork and jumping through other hoops required by government and the insurance industry, unremunerated hours that don't directly benefit their patients. Good doctors, who often accumulate tens of thousands of dollars in debt to obtain their education, should be paid well. So should good nurses. This is an issue that seems to get lost in the healthcare debate.

As a new heart patient, I am on the blood thinner Plavix, which costs about $5 a pill. Without Plavix, it is quite possible that a blood clot could form around the stents and I could die. Given the high cost of many prescription drugs, it is easy for people to demonize the pharmaceutical industry. But Big Pharma is a life-saving and life-sustaining industry. Healthcare reform needs to address the high costs of prescription medications by making them affordable for patients, especially those with little or no insurance-but not at the expense of research and development for new drugs, which is extremely costly and is only recouped through patent protection. How to achieve this balance is one of the conundrums of healthcare reform.

Soon after I returned home from the hospital, the bills and Explanation of Benefits started flooding in. The initial bill for my first surgery was a whopping $53,000. But my insurance company quickly reduced the charges to about $17,000 using a "pre-determined negotiated rate." While heavily "negotiated" discounts on doctors' fees and hospital charges can make it difficult for them to recoup their expenses or generate the income they may very well deserve, for the healthcare consumer--who even with good insurance might have to pay 20% of the final bill--seeing that total amount reduced is a blessing.

And this points to another paradox of our current system. On one hand, the doctor (who deserves to be well-paid) is the patient's chief advocate, looking out for the patient's best interest in terms of health and well-being. But on the other hand, the insurance company (or the government) also acts as an advocate for the patient, by reducing what the doctor, hospital, or pharmacy can charge. These two "advocates" for the patient exist in an adversarial and potentially hostile relationship. And of course, sometimes insurance companies or Medicare/Medicaid will second-guess doctors and refuse to cover certain procedures or tests that are legitimate, and sometimes doctors will order tests that indeed may not be necessary. This is part of the "game" that has become integral to the current system. Is such a model of healthcare delivery cost-efficient or even sustainable? Would a "public option" for all Americans (and not just the poor or elderly) make the situation any better?

When it comes to healthcare reform, there are more questions than answers. We need to be able to effectively guarantee healthcare for all Americans, but without reducing the quality of care or the incentives for healthcare professionals, pharmaceutical companies and others to continue doing what they do best. One thing is certain, however: we won't be able to address the complexities and contradictions of the current patchwork system if we leave it to the usual self-serving rhetoric and recriminations of partisan politics.