Written by Larry Sobal, CEO, Appleton Cardiology Associates

Dear President Obama: I'm trying to deal with the sting of not being one of the 150 invitees to your recent White House Summit on Health Reform and can only assume you mistakenly left me off the list.

No doubt you are overwhelmed learning what a big hairy complex beast our health system is and how elusive solutions can be. That's not a surprise to us in health care, since we have watched a stream of so-called reformers (politicians) condescend their solutions upon us and often make matters worse.

I'm encouraged by your intentions. As noted in your summit speech, "Every idea must be considered, every option must be on the table" and "we'll need a process that is transparent and inclusive as possible."

1. You proclaimed there would be "no sacred cows." I wholeheartedly agree and insist that every aspect of our industry, including government, providers, insurers, employers and consumers be asked to give up some of the status quo.

2. Ultimately a redesigned health care industry will involve more incentives that use risk and return to improve performance.

3. You've consistently stated that you are not in favor of a single governmental payer system. That's sound wisdom and we are on the same page. However, let's also make sure that a mixture of public and private insurance does not continue (or worsen) the many imbalances that currently exist.

4. Your recent stimulus package included a governmental push for Electronic Medical Records. These days, virtually every employer is desperately searching for how to reduce unnecessary spending and learning what are real versus phantom cost savings.

5. Another stimulus package concept to tread cautiously on is "comparative effectiveness research." I know what you're thinking so cut me some slack, as I'm not paranoid on the topic like Rush Limbaugh.

6. Let me tell you where you are not spending enough money. Yes, I know the stimulus package includes $500 million to divvy up for health care training and education — much of it targeted toward getting physicians into disadvantaged communities. However, there needs to be much more effort focused on maintaining a strong primary care base of physicians and midlevel providers and I don't think you realize how urgent that need is.

7. Your speech emphasized, "We can no longer let the perfect be the enemy of the essential." I'll counter with "Don't be held hostage by false deadlines." I know people are demanding that reform legislation be passed as early as this summer. I'm relying on you to find the right balance between haste and waste. These decisions will have an impact for decades and require thoughtful restraint over impatience.

I'm here to serve, Mr. President. As you move forward with trying to facilitate a plan, keep me in mind. I have a whole slew of other ideas if you are interested. Remember, as opposed to some of your other health care experts, I pay my taxes.