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There is no doubt that health care reform will be a top issue when the New Mexico Legislature reconvenes in early 2008.

Several far-reaching plans have been studied, and Gov. Bill Richardson says that he expects to have a plan that combines the best aspects of each of the three proposals into one major reform effort.

While details of the final plan are still forthcoming and will be subject to change based on the legislature's priorities, at the heart of any reform effort is the fact that we must restore the sanctity of the physician-patient relationship.

President Bush proposed one major step in that direction in his State of the Union address this year when he asked Congress to give individuals the same tax benefits for health care as their employers are given.

Since employers contribute no tangible benefit to their employees' health care that could not be provided without them, employers are little more than "middlemen" that stand between individuals and their insurance providers and doctors. Cutting out this unnecessary layer would give patients greater say over their insurance providers and plans, thus helping to restore the patient-doctor relationship that has become all-too-tenuous in recent years.

While Congress has failed to act on the president's proposal thus far, an alarming trend has cropped up around the country that illustrates how third-parties now more than ever come between doctors and their patients. The trend is that physician compensation is being linked with the percentage of generic medications they prescribe, regardless of the medication that might be most appropriate for the patient.

A recent Boston ABC-TV news story told of thousands of patients that had been prescribed a brand-name cholesterol drug being switched to a different drug that happens to be generic. The doctors who did this got paid $100, per patient, by the insurance company. There were 2,400 patients switched by their doctors with no disclosure that the doctor was being paid to do so. While this may not be illegal, is it ethical?

While generics can be a reasonable option for many cost-conscious patients, replacing a brand-name drug with a generic without telling the patients is a questionable move at best. This is a clear example of how insurance companies are sacrificing care over cost, thus placing the physician-patient relationship in danger.

It is also something that might not occur if patients were viewed by doctors as "customers" to whom they were responsible as opposed to the insurance companies that most often pay the bills and are not even chosen by patients.

The point is that the patients deserve to be told when their doctors are being paid to change their care, and the people who pay for the care need to be transparent about the behavior they are driving - money over patient interests.

Unfortunately, while Washington has failed to act on reforms, none of the three plans expected to be considered before the Legislature would do much to restore the doctor-patient relationship.

The Health Security Act in particular which most "reform" activists favor and would create a state-run, single-payer system that would do little to really "reform" health care aside from replacing insurance companies and employers with government bureaucrats. While it may seem better to have only one middleman (government) between patients and doctors than two (employers and insurance companies), when cost-cutting measures are called for - as they inevitably will be - what control will patients have over the services their doctor provides? Quite simply, the answer is "almost none."

Part of the Hippocratic Oath taken by doctors is "do no harm." The best way to ensure that no harm is done is to restore the doctor-patient relationship.

While New Mexico policymakers have limited control over health policy, they should keep that oath in mind as they attempt to tackle the state's health care problems.