Health care is the topic du jour as it has rightfully gained its leading position in our vernacular.  Let’s face it, if the cost of health care delivery continues to rise at its current rate and the quality continues to slide at its current rate, in a few years we will see a catastrophe that rivals the sub-prime loan market.  I like to think about health care as a bicycle wheel with many elements that combine to make it successful.  Each spoke is a key element: access to care being a spoke, physician medical practices being a spoke, pharmacies being a spoke, the patient being a spoke, hospital treatment being a spoke, health innovation a spoke, sickness research a spoke…on and on.  Many factors contribute to our health system to make it successful and many factors contribute to make it fail.  We must now review the system from point to point and dissect how each spoke must change in order to reinvent our health system in a manner which makes it effective and efficient for the long term.  We must create industry-wide standards for electronic medical record systems so that data collected in a physician’s office can be uploaded to a patient’s electronic medical record.  Industry standards will allow for the integration of all providers and payers.  We must create transparency by publishing the costs of drugs, devices, procedures and consultations and allow consumers to make informed decisions about where and how they will accept care.  Consumers will quickly find that alternative delivery venues like the Internet will save significant health care dollars.  By having an on line medical record available to patients at all times, patients can decide what information needs to be given to a health care provided.  There will be less duplication of laboratory tests, less confusion as to a patient’s medical history and an ability for health care professionals to see baseline data.  An integrated system will allow us to have superior care for fewer dollars.