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Soon we will be deciding the fate of the free world by electing a new U.S. president. We will then be debating the health care of our country’s citizens. Physicians are poised to be on the forefront of this debate.

My hope is that scientific evidence, and not opinions and rhetoric, are used to progress through this arena. All too often, lobbying efforts influence our congressmen and defeat common sense. We will only make a difference if we stick to reality.

For my part, as the Collier County Medical Society president, I have been involved in medical politics for years. My experiences have been eye-opening. Washington is engulfed in a culture of winking and ulterior motives. It’s difficult to determine who really wants to help move the issues along.

The Florida Medical Association (FMA) has been the shining star in this health-care debate. More than once, the Florida representatives to the American Medical Association (AMA — America’s largest physician organization) have brought intelligent conversation to the negotiating table in Washington. Disasters have been remedied with the able thinking of our Florida delegates: For example, the pay-for-performance issues physicians are dealing with today.

Most insurance companies want to rank physicians based on “quality,” which is defined as a physician’s ability to save the insurance companies money. The AMA has decided that this flagrant abuse of the physician-patient relationship is unacceptable.

My goal as a gynecologist, and the goal of all physicians, is the well-being of our patients. Our “quality” comes from the betterment of our patients, not from the swelling pocketbooks of the insurance companies. The only yardstick to measure our success as physicians should be the improved health of our patients.

Our patients should also become more responsible for their own health care. Frequently, we expect modern medicine to compensate for our own personal decisions. We cannot pick our genes, our parents or some illnesses, but we have the ability to decide what we put into our mouths and lungs.

Many overweight patients ask me for weight loss products. I ask them, “How much do you exercise?” The usual response is dismal: “I’m always in and out of my chair at work,” or “I chase my 2-year-old around all day.” These are the bare minimum activities to survive; they’re not exercise. Normal daily living includes walking, lifting things, and moving your body. The United States has the fattest citizens in the world. Our health care system is stressed because of this.

Taking care of obese people and smokers requires more financial responsibility than almost any other personally-inflicted disease known.

Caring for your body doesn’t mean driving it like a car. It means doing regular maintenance before problems occur. It amazes me that we take better care of our cars than we sometimes do of our bodies. Interestingly, we never expect someone to pay our bill for this maintenance like we do for our own health maintenance. I’ve never left Sam’s without expecting to pay for my new tires, but I frequently see patients leave my office with a sour taste in their mouth when asked to pay a $25 co-payment as required in their insurance contract.

Our priorities and expectations have become so deranged that we’ve allowed ourselves to believe that others should be responsible for our own well-being. Insurance companies aren’t in the business of caring for people’s health. Insurance companies are beholden to their shareholders, not to the patients or the doctors.

Yes, the patients are the customers for these companies, but not really. Since most people get their insurance through their employers, insurance companies feel that a few complaints here and there are probably insignificant. One major consideration for employers is cost. Therefore, we are stuck in this vicious cycle of allowing our own health care to be controlled by others. It infuriates me to think that I have lost personal control in deciding my family’s health care.

Every election cycle, there is renewed talk about health care issues. Rightly so. We are an aging society with greater needs for health care, enough to eventually break the Medicare bank. Our personal responsibility should begin when we are young, not when we retire. Taking care of oneself — eating right, exercising regularly, not smoking — all lead to less reliance on insurance companies to “act on our behalf.” If we move back to the basics and rely more on ourselves for our well-being, the better off our entire society will be.

The start of any health-care reform package should begin with the individual, not the unknown giants with swelling profits and bank accounts.

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Dr. Gauta, a board-certified gynecologist, has been practicing in Naples since 1998. His expertise includes all aspects of obstetrics and gynecology, with special training and emphasis in urogynecology. He completed undergraduate studies at Siena College in Albany, N.Y. His medical degree was completed at Albany Medical College; he did specialty training at Tulane University. He is on the boards of the Florida Medical Association, the Florida Medical Association Political Action Committee and Leadership Collier.