En route to work today, we could not help but overhear a conversation between two men sitting behind us. One was about 35 or 40, and married to an oncologist. The other was maybe 55. His sister is an oncologist, and he has another physician-business consultant in the family in Massachusetts. The conversation went something like this:

Older man: How are things at the hospital?

Younger man: The hospital is hurting because of the economy but the oncologists are doing fine. Cancer treatment isn't elective. Besides the payment system is great for oncologists. They get paid by procedures. And they do lots of procedures. It's not like the pediatricians in the office practice. They're getting killed, insurers don't pay much.

Older man: Yes that's what I hear. My sister is at Kaiser Permanante, so she doesn't make as much as some of the oncologists in private practices, but still she likes it.

Younger man (sounding apologetic): My wife is in academic medicine so she isn't making as much as other oncologists either. But really, if you do procedures, you get paid a lot. It's all about procedures.

Older man: I read somewhere that only about 15 percent of medical students want to go into primary care. You can't blame them. They don't do procedures.

Younger man: Yeah, I read some article somewhere that the more specialists you have, the more procedures get done, and it costs more. And the places with more primary care—it costs less and the patients do as well. The system though, it's all about procedures

Older man: Do you think they are going to pass this health reform bill? They really have to. The system is broken. It's going to just fall apart "

Maybe lawmakers should spend a little more time on the Metro...