On Nov. 7, our United States House of Representatives passed a health care bill to be forwarded to the Senate. This nearly 2,000-page bill is filled with many yet to be discussed and even denied requirements for all of us.

Prominent examples are found in Sections 202 and 224, pages 91-92 and 118, which require everyone to enroll in a "qualified plan." If you are already insured through an employer, your employer will have a "grace period" to switch you to a "qualified plan." The "qualified plan" definition is one that is yet to be described and will be defined by the secretary of Health and Human Services. The secretary will also determine how much you will have to pay for your coverage.

If you personally purchase your health care insurance, you will have to immediately participate in a qualified plan when any terms of your contract change, such as co-pay, deductible, or benefit. Eighteen months after the bill becomes law, the secretary of Health and Human Services will decide what your plan will cover and how much you will be legally required to pay for your coverage.

In Section 59b, pp. 297-299, you are required to include proof that you are covered by a qualified plan when filing your taxes. If not, you will be fined a significant (financial) penalty. Illegal immigrants are exempt from this requirement.

This "qualified plan" is a poorly concealed first step toward a single-payer "government system."

Government systems, as examples in the United Kingdom, France, or Canada, usually result in a monopsony, a market condition where there is only one buyer for a product or service. Where this has occurred in health care, several undesirable consequences, (intended or unintended) occur.

1. Lessened or absent competition for products or services, therefore less choice and generally poor quality.

2. Long waiting times for services as seen in Canada for elective orthopedic procedures.

3. Rationing of care, medications, tests, procedures. In the United Kingdom, this is demonstrated by their program, QALY's, Quality Adjusted Life Years, overseen by their National Institute of Clinical Excellence group, which determines the criteria for QALYs. They determine who will receive care and for how much. The comparable concept in the United States is to be mediated by the Independent Medicare Advisory Commission created by our current administration in Washington.

4. Increased cost. Four years after it was implemented in 2003, Maine's Dirigo Care, fashioned after Medicare, increased insurance premiums 74 percent, while only insuring 3,400 of originally 128,000 uninsured. The cost has been $155 million while initially budgeted for $50 million.

As a physician, the following two consequences are the most disconcerting as seen in the United Kingdom.

• Deferred or neglected infrastructure support of the health care institutions. Their hospitals suffer from inadequate funding for maintenance and new technologies.
• Minimal research and development. In the new health care plan there is a punitive assessment on the medical device and pharmaceutical industries, decreasing profitability and monies available for the high-risk attendant in research and development of new breakthrough products.

My concern about our loss of research and development is related to a recent statement by Ezekiel Emanuel, who is active in health care policy formulation, and the brother of the current administration's chief of staff: "The major contributor to the rapid rise in our health care costs is due to the constant innovation of new technologies, devices and drugs paid for by insurance."

As a physician, my response is to keep innovating for the sake of current patients and future generations. We will have breakthroughs for the treatments and some cures for cancer, Alzheimer's disease, and cardiovascular problems through innovation.

Do we need health care reform? Of course, but not restructuring of our entire system. Let us address the issues that are critical through reforms of the insurance and legal (tort) systems. Address the uninsured by subsidies and tax abatement. Use best medical practice information to inform and assist patients to make better choices and encourage healthy lifestyle opportunities through incentives.

This is a seminal moment for the future of our health and the health of subsequent generations. Let us make a better, informed choice.

Donn G. Duncan, M.D., an international authority on patient classification systems and the computer-based patient record, is active in health care policy formulation and implementation. He lives in Santa Fe.