National health care is a work in progress that needs thoughtful attention. Although Congress and the Obama administration may want to use this momentum to push their agenda, we need to discuss it, instead of quoting conventional wisdom engineered by vested interests to keep us from thinking and questioning.

We must ask: Does health care itself need fixing, or is it the health care system that needs fixing?

Does medicine alone account for the expense of its current delivery, or should we include in that cost three major segments, none of which contribute to our health or healing, segments that substantially impact the cost of medicine?

These segments are insurance, law and government. Each of these nonmedical layers supports thousands of nonmedical persons pushing paper in huge buildings, all on our medical buck. These segments not only add to the expense of medicine through duplicating processes, they can also distort it.

When insurance companies or governments determine whether or not a doctor’s diagnosis and treatment should be paid for, they not only duplicate much of the process through handling and reviewing each case, they distort medical practice by deciding what medical expenses they will cover. This leaves the doctor, who diagnoses and treats your illness, in the predicament of choosing between their dictates and his or her medical judgment

Court decisions also distort and duplicate medical practice through exorbitant awards. This leads to higher malpractice insurance. The result is defensive medicine, which duplicates and distorts.

Are the courts the proper place to determine medical claims? Isn’t a trial an intricate, expensive game featuring many players who are not necessarily medically informed, who sometimes judge emotionally, rather than knowledgeably, on a lot of medical information?

Is this expensive crapshoot the way to rectify serious medical issues?

Medical issues most assuredly need oversight, as do judgments regulating medical practice and delivery. These deliberative processes need to be reviewed and reinvented to make sense, not take cents.

There’s health, then there’s care

Health and care are separate but integral to the practice of medicine, according to former Surgeon General David Satcher. Dr. Satcher contended during a recent TV interview that “health” is a primary ingredient in reducing health care costs.

We should enlist our regional medical groups to lead in the creation of health programs that promote better health in our schools, workplaces and homes, programs designed to improve our national health and reduce health care expense.

The “care” part of the discussion isn’t failing in this country. Medical research and teaching centers in every state support the advancement of medical skills. But through advanced technology, couldn’t these skills be transported more broadly?

The system of delivery is the extensive medical infrastructure that already exists throughout the country. These assets should be evaluated to determine what types of infrastructure (hospitals, clinics, offices, mobile medical units) are best to expand service.

Government grants produce jobs in a weak economy but are not budget-busting, long-term entitlements. Grants could be awarded to develop infrastructure in areas with underserved populations, to target advances in technology, for communication and information coordination programs, and for improved delivery of care and health programs.

President Obama recently awarded the Presidential Medal of Freedom to Dr. Pedro Jose Greer of Miami, who built a primary care clinic to treat disadvantaged children and adults in the Little Havana community. He also supports another center that treats 10,000 homeless persons annually.

Dr. Greer understands how to deliver medicine to the underserved in society. Such programs illustrate how to develop medical infrastructure specific to the needs of a community with medical personnel who are trained in the skills targeting those needs.

A health and care program for a preschool is not the same as one for a senior center, nor does a small farming community need what Miami’s Little Havana needs.

The point: This effort must not be a “one-size fits all” solution dictated by government.

Delivery systems must be focused on individual community needs in order to expand medical skills both economically and successfully.

Would you care to recommend the government’s talent for creating ever-expanding budget problems like Social Security, Medicare or prescription drug entitlements as the paradigm for prescribing an additional segment to our medical care system?

Yet Congress and the administration are pushing an insurance program as the solution.

We are being rushed to a trillion-dollar government-directed operating table for haphazard, exploratory surgery, for which added insurance entitlement we’ll be stuck paying — forever!

Scary thought: How many Americans would feel comfortable being on the operating table surrounded by politicians filibustering whether to operate and which knife to use first? Is it any scarier than letting them decide what medical decisions to cover with what insurance?

An insurance program dictated by Congress is nothing more than a whitewash. Health and care systems are far more complicated and important a concern than to be treated with such an impotent solution. Insurance is useless if there is no medical access available.

Everyone should think beyond the parameters now set by the powers that be.

Each state, region, community and medical group should evaluate what it has, where it is weak and what it needs to extend and improve delivery. Not an easy task, but unless we know what systems work for what needs and how to deliver medicine to more people, throwing money at health and care reform through an insurance entitlement is simplistic, expensive, ineffective and downright insulting.

• Nancy Matthews is a longtime newspaperwoman associated with the Tracy Press.