Internal Medicine 2010, the annual meeting of the American College of Physicians, provides a comprehensive overview of the major clinical and policy issues in adult medicine today. ConsultantLive brings you the highlights of the meeting with reports on key presentations and interviews with leading experts.

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Featuring Joseph A. Lieberman III, MD, MPH, Associate Editor of the Delaware Medical Journal and Professor of Family Medicine at Jefferson Medical College.

Phillip arrived at the appointment for his first psychiatric outpatient session, filled out the paperwork, told me he was depressed, shed a tear, and became completely silent. No amount of coaxing from me could get him to talk. He looked down or into space, avoiding my eyes, and just sat there for the entire 50-minute session.

The pharmaceutical industry aggressively supported efforts to pass health care reform, even pledging to trim drug costs by $80 billion.1 In addition, it pumped millions of dollars into lobbying and ad campaigns to push the legislation to a successful conclusion, even joining with groups such as Families USA, which ironically spent years attacking drug makers in the early part of the decade.2

The recent signing of health reform legislation signals a watershed event in the delivery of health care in our country. It is the culmination of a tangled legislative battle, but it ignores 3 of the 4 pillars of health reform. In this article, I describe these pillars, and then outline where recent legislation falls short.

The sweeping health care reform bill signed into law in March will eventually provide coverage to 32 million more Americans, but the Congressional Budget Office has estimated that about 23 million will still be without health care by 2019.1 Even those with insurance may continue to have high out-of-pocket (OOP) expenses, because coverage premiums and medical services outpace household incomes.