What docs think: Doctors speak on the state of health care in the county

[okarol]

6/14/2009 5:27:00 AM                         

Dr. McBee
What docs think
Doctors speak on the state of health care in the county

By KATHY ANEY
The East Oregonian

Back in the days of horse and buggy doctors, paying for health care was a much simpler process.

If a farm-dwelling patient couldn't afford payment, he might offer a chicken in return for services rendered or promise to pay after harvest.

What a difference a century makes. Now we have the third payer system - private insurance, Medicare, Medicaid. Costs have spiked and health care expenses consume our paychecks. A single chicken no longer cuts it.

"Our health care system is simply broken," said U.S. Sen. Ron Wyden, D-Oregon, during a recent floor speech. "Medical costs are gobbling everything in sight."

Private insurance companies cherry pick, he said, accepting healthy people and funneling sick people into government programs. He dreams of a system that takes all comers, awards prevention and wellness and has portability from job to job.

The East Oregonian questioned four local doctors about the imploding U.S. health care system.

The physicians - Dr. John McBee, Dr. Jon Hitzman, Dr. Nancy Rudd-McCoy and Dr. Norm Sitz - agreed with Wyden that the U.S. system is broken.

"The whole system is crashing," said Sitz, who practices internal medicine in Pendleton. "Everyone realizes that."

Whether a national health care system would fix the problem gets a mixed review. Dr. John McBee, a Pendleton surgeon, thinks not.

"I'm totally and completely opposed to a single payer system," said McBee. "It's a disaster in Canada. It's a disaster in England. Access would be much impaired."

Hitzman and Rudd-McCoy said a one payer system is a good idea, but only if the government isn't the payer.

"Governments run bureaucracies," said Rudd-McCoy, a Hermiston obstetrician/gynecologist. "They are unresponsive to people."

"It certainly would streamline the process to have a single payer," said Hitzman, a family practitioner. "But not if the federal government is the payer. Our government is too big and too unwieldy."

Sitz, however, sees few alternatives.

"It's our only chance," he said.

Nationally, the majority of doctors appear to favor national health care. An Indiana University study revealed that 59 percent of American doctors support such a system, while just 32 percent oppose it.

That's up from a similar survey the university did in 2002, when 49 percent supported a one payer plan and 40 percent opposed it.

A national health care system would mean fewer options for Americans who are accustomed to quick access to high-tech diagnostic equipment and a smorgasbord of health choices.

"Single payer system is code word for rationing," McBee said.

In countries with national health insurance, a person with, say kidney failure, might not be eligible for dialysis if they are over a certain age. Even if a procedure is available, patients might have to wait for many months for it.

That notion of rationing brought a variety of reactions from the physicians.

Hitzman said no health care system can offer quality, speed and low price in one package.

"You can only have two, you can't have all three," he said. "If you want cheap health care, you will give up timeliness or quality."

Quick, quality care is the essence of the American system. However, in Canada, someone with a torn meniscus might have to wait four months for surgery, though cost would be much lower.

Rudd-McCoy said Americans expect too much from their health care system and they lose touch with how much things actually cost.

"People expect perfect results, cheap, right now - it's not real," she said. "Everyone wants everything - that's a formula for ever-increasing health care costs."

Even the U.S. system doesn't offer full access, said the physicians.

"No matter what system you have, there's rationing," Sitz said.

Insurance companies deny coverage or people simply lose their coverage altogether.

Hitzman shakes his head at the nation's 50 million uninsured citizens.

"A system that can't address the health care needs of 50 million people is broken," he said. "Our system is employer based - if you lose your job, you are uninsured."

The physicians worry about Medicare, calling it an archaic system on the verge of going bankrupt. For years, doctors have complained that Medicare reimbursement for doctors' services is laughable - only about 33 percent of costs.

"Do attorneys take only 33 percent for their 65-and-over clients?" McBee asked. "No. Who else does that? No one."

McBee said he continues to take all comers, and often writes off those who can't pay, but the low Medicare reimbursement rates make it tough.

"It's hard to remain viable when these forces continue to bear," he said. "It's so vexing."

McBee thinks part of the answer could lie in aligning benefits with ability to pay.

"Why should Ross Perot get the same amount as a guy in Mission sitting in a trailer with no money?" he said.

Another factor, they said, is the threat of malpractice which hovers over their heads and requires expensive insurance.

All the doctors said they shove anxiety about a crashing health care system aside in their daily lives.

"Doctors vent," Sitz said, "then they go back to their offices and see their patients."

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