People say no one knows what to do about health care.

Baloney. Lots of people know what to do. Patients and physicians need to start the work.

Societal leaders need to take specific actions, but the beginning lies with patients and doctors.

Physicians need to:

* Put our own houses in order.

We need to improve access to us. An appointment days after a sick person calls, to see someone they do not know, is not access.

Specialists need to stop demanding that primary care physicians fill out their form when we have sent an adequate one. Barriers need to come down.

* Agree that we will all be paid the same.

This will need malpractice reform but it must be done. Our professional societies need to take this on.

Doctors who read X-rays should not be paid four times what primary care doctors make, as one example.

* Get back on the same page with patients. Doctors should advocate for patients and partner with them, not protecting ourselves from them.

We need to be vocal that the Food and Drug Administration and drug companies provide us with accurate information on medicines we use. We ought to look at the many policies that run counter to the best interest of patients.

* Stop fragmenting care. We need to pay primary care to do its work and stop outsourcing every organ.

The Veterans Affairs system fragments care dangerously and expensively. It needs to be subsumed into the general system. We cannot afford two sets of hospitals/clerks/executives/furnaces/and paper work.

We all need to:

* Watch our language:

Access to insurance is not access to care. Universal care is not single-party payer. How we structure payment has many possibilities, but care for all is obviously the right thing to do.

And let's stop talking about reimbursement and payers. I do not want to be reimbursed by a payer. Reimbursement means I get part of my fee, weeks after providing a service, from someone other than who I provided the service too, after filling out complicated forms that are often rejected and sent back to be redone.

* Stop the incomprehensible over-priced insurance business from being involved in daily health care. Your car insurance isn't used for every fillup! Insurance should be simple catastrophic only insurance.

Doctors should look at what taking insurance really means. Employers and states, who buy the bulk of care, should contract directly with providers of care when possible. Primary care is cheap and good primary care keeps people out of hospitals and emergency rooms. Employers should stop buying these bad insurance products. Doctors should stop agreeing to be paid in ways that take them away from patients.

* Get patients and doctors back on the same side.

* Stop looking at legislators to fix this. They won't and they can't. There is as much waste and inefficiency in the government as in health care. What lawmakers can do is pressure for simple catastrophic insurance to be available, and they can allow doctors to talk about all this without fear of collusion,

Patients can:

* Learn how health care works. Stop saying they cannot understand it. If I can understand it, you can.

* Stop insisting that they get everything they saw on TV or every unneeded test because they are frightened. Be willing to sit down and work with a doctor over time.

* Participate in a thoughtful way in their care. Stop insisting that they be given a paper the size of the map of the United States to explain medications, while taking billions of dollars of unregulated supplements on their own.

Physicians can regain peoples' trust if we provide access and slow down. For that, we need to stop working with insurance companies and be paid equitably.

There are readily available steps every single doctor, patient and employer can take to re-engage with each other, cut out bureaucracy and go back to healing.

Change starts at home.

Jean Antonucci is a family practice physician in Farmington.