Paging Health Care Reform: Doctors Weigh In

Health care remains a hotly debated topics in American politics. President Obama announced he will take the issue to the American people, in a series of planned town hall meetings as Congress debates the best way to implement reform. A group of physicians with diverse constituencies share their thoughts of the president's proposed health care plan. Hear from Dr. David Ellington, a family physician in Lexington, Va.; Dr. Hector Flores, of the Family Practice Department at White Memorial Medical Center in East Los Angeles and Dr. Carolyn Barley Britton, of the National Medical Association.

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MICHEL MARTIN, host:

This is TELL ME MORE from NPR News, I'm Michel Martin.

Coming up, the latest Baseball Hall of Fame inductions were this weekend. We'll tell you more about one of the greatest ball players of all time, Satchel Paige. As famous as he was, his life story still had many mysteries - until now. But first, more on the topic that is consuming the attention of the country's top leaders, health care.

President Obama is expected to go back on the road this week in support of health care reform, following last week's aggressive schedule of press and public appearances. He's pushing Congress to finish legislation to extend health coverage to those who don't have it, and lower cost and improve quality for those who do. But congressional leaders are saying they need more time and will not meet his August 7th deadline.

And in the meantime, the country is becoming more divided about whether or not the plans being debated by Congress will work. A recent Washington Post/ABC news poll says 44 percent of Americans disapprove of Obama's handling of health care. On Friday, we talked with a group of political analysts to get a sense of how this effort is proceeding.

Today, we decided to check in with a diverse group of doctors, who we've been talking with from time to time, to get a sense of what this looks like from their perspective. Dr. David Ellington is a family physician in Lexington, Virginia. He joins us from Williamsburg, Virginia. Dr. Hector Flores is chairman of the family practice department at White Memorial Medical Center in East Los Angeles. He joins us from his office there. And Dr. Carolyn Barley Britton is president of the National Medical Association. She joins us from the Las Vegas Convention Center. Welcome back, doctors. Thank you so much for speaking with us again.

Dr. DAVID ELLINGTON (Family physician, Lexington, Virginia): Thank you for inviting me.

Dr. CAROLYN BARLEY BRITTON (President, National Medical Association): Thank you so much for having me. you.

Dr. HECTOR FLORES (Family Practice Department, White Memorial Center, East Los Angeles): Thank you for having me.

MARTIN: Let's start with some remarks by the president last week at a town hall meeting that he held in Shaker Heights, Ohio. Here's what he had to say.

President BARACK OBAMA: If you have health insurance, the reform we're proposing will give you more security. You just heard Rick's story. Reform will keep the government out of your health-care decisions, giving you the option to keep your coverage if you're happy with it. So don't let folks say that somehow we're going to be forcing government-run health care. It's just not true. And it will keep the insurance companies out of your health-care decisions, too.

(Soundbite of applause)

MARTIN: I want to go around and ask each of you if your patients believe this - recognizing that you don't have time, most of you, to have deep discussions about policy while you're in the examining room. But Dr. Ellington, let's start with you. To the degree that you have a sense of what your patients think about this, do they believe that their lives will be better if the Congress proceeds with these plans to overhaul health care?

Dr. ELLINGTON: Michel, from what I've been able to talk about with my patients in the exam room, it boils down to three emotions. Probably number one is a great deal of anger and frustration with how the environment has either evolved -or devolved - into the condition and the mess we're in right now. There's a tremendous amount of frustration about high, unaffordable premiums when at the same time, they look and see that the insurance companies are posting large profits.

That's very frustrating and makes them very angry. There is an element of fear that maybe they won't have as good a plan as they have now, or maybe they won't be able to have a plan. But this is all overlaid with what I keep hearing over and over again. And this must be imprinted in the DNA of Americans, because it's the hope that something will be done. So that's sort of the landscape that I hear.

MARTIN: Dr. Flores, what about you?

Dr. FLORES: Very similar. I think my patient population is about - over half are low-income families. So they're covered by either Medicaid or state-sponsored programs. For example, the Healthy Families, which is the state version of SCHIP. Most of those folks are excited about the prospect of reform because they've experienced access problems through the Medicaid program, and through some of these other state-sponsored programs.

So they see this as potentially expanding their opportunities for options for service. Those who have commercial insurance are a little bit concerned because they're starting to catch the soundbites of the debate about government-run health plan. In general, they're open-minded and therefore ask us, and ask me and my practice, what my thoughts are about it, and I think I can, you know, provide them a balanced perspective 'cause that's what I've tried to do with my colleagues in the medical community.

MARTIN: Hmm, that's interesting. Dr. Britton, what about you? And I do want to mention the National Medical Association, which is an organization primarily of African-American doctors, has long - as a policy of the organization - pressed for some form of public option, some form of universal coverage as a matter of policy for the group. So tell me, what are your patients saying and what are your colleagues saying?

Dr. BRITTON: They're like three items. And I'd say number one is hope, really hopeful news that perhaps we will put together a change that is needed. Second is uncertainty about some of the elements of the change. Is the change going to be dynamic enough? Is it really going to get at the structural problems that need to be fixed for our community? And the other is a sense of lack of control over the process.

But I think that it is really recognized throughout our associations, in both the physicians - even those who are doing well - this entire system is not workable in the way that it is. And I compare this to really, almost like a health Katrina. For years, people warned that the levees were weak and would not sustain a cat 4 or a cat 5 storm. What nobody could tell you is when the moment would come that there was a stressor that the levees would break.

And I feel we're in the same way, and our association does in many ways feel the same thing, that we're at a point where a lot of things in our health system just are not working properly. And what we don't know is when they'll be a stressor that really collapses the part of the system that seems to be working very well for some of us on the upper end.

So we are hopeful that we will be able to do it. And I think there's another dynamic - is that people do believe that President Obama has a good intention for the American public, not just a political motivation for doing health-care reform.

MARTIN: I want to pick up on that, Dr. Britton, in just a minute but before I do, I just want to tell our listeners that if you've just tuned in, you're listening to TELL ME MORE from NPR News. We're talking about the health-care overhaul plans currently being debated in the Congress, and what people are saying about those plans.

And our guests are Dr. David Ellington, a family physician in Lexington, Virginia; Dr. Hector Flores of the family practice department at White Memorial Medical Center in Los Angeles; and Dr. Carolyn Barley Britton, president of the National Medical Association.

We've been checking in with this group of doctors from time to time because they are a diverse group, and they represent a diverse group of patients. And we're checking in with them to find out how they're reacting to the policy debate going on in Washington.

Dr. Britton, I wanted to pick on something that you said about the sense that this is a Katrina, a potential Katrina in health care. That it's slow moving, but when - if a disaster happens it's going to affect a lot of people, and it's going to be very painful. We had an interesting discussion with a current member of Congress, a former member of Congress, and a very influential blogger last week. And the consensus, at least among the politicians, was that it's harder to vote for a change than it is to let the status quo alone. And I wanted to ask each of you, do you buy that? Dr. Britton, I'm going to start with you.

Dr. BRITTON: Well, I think there is always a lot of resistance at a congressional level if things seem to be successful. If they do a poll and they say 75 percent of the American people say we have great health care, well, that's not actually how you measure health-care outcome. It's not a subjective measure. It's an objective measure, and it's an objective measure according to standards.

So the 75 percent of the public may be uninformed about that. So personally they feel like they're doing okay, but they don't actually know that. So that's what the politicians take advantage of. The real issue we face is the failure to plan. When the crisis hits, it's like the failure of the banks; you're going to take Draconian action. And the way in which we have been going, sustained over the last decade, says the crisis will hit. So we should, in the light of our recent experience, with variable institutions going down, have at least some measure of thought that we need to take this seriously and begin to prepare. And rather than have it be a political football, have it be a way in which we develop a consensus about what needs to be done.

MARTIN: Well, politics is the means by which government happens. So, Dr. Flores, what do you think? Do you think that the public shares your sense of urgency about the need for a change?

Dr. FLORES: I think the concept of change definitely is supported, but you're right about the earlier comment, that there is no real definable political price for opposing reform - if an elected official can find some wiggle room in saying, I supported incremental changes. And it also depends a lot on their district. If you're in Flint, Michigan, or East Los Angeles where I am, and you have a high percentage of uninsured patients, you're going to hear about it if you don't act to create some change. But if you're in a more affluent community where the physicians and the hospitals themselves are questioning whether they should support change, there's not that much risk.

MARTIN: Well, Dr. Ellington, what about you? You have a very diverse patient population. Each of you does, in its own respect, but Dr. Ellington, you know, you got patients with zero access or very little access, very little insurance. And you've also got patients who are fully insured. So, what do you think about that? Do you think that the people that you see every day will hold politicians accountable for change, or do you think that either the status quo is acceptable enough, or that they're afraid enough of change to not?

Dr. ELLINGTON: Michel, no one likes change. Doctors don't like change and so it's not unusual for politicians to resist change, or patients to be wary or afraid of change. I would say that the people who are well-insured with a good paycheck, right now, their level for risking change is much, much lower than the people I see in the free clinic, especially the markedly increasing number of people that we've seen within the last six months who had jobs, lost their jobs, and then lost their insurance. They really want the change.

But to try to pick up on something that Dr. Britton said, you know, you can repair the roof during good weather, or you can try to repair the roof in the middle of a hurricane. And I think when you're repairing the roof in the middle of a hurricane, those are the Draconian, on-the-spot changes that you make, which may not be good long-term changes.

I'd also follow up on her and tell her that we know what the Katrina is. And the Katrina is the fact that last year, we had the lowest number of American medical school graduates ever in history to go into primary care. And our system right now is totally unsustainable financially and just from a system point of view. And so that is the Katrina that's coming. And if that's not addressed, then it's going to get worse. And unfortunately, that is not on the radar of a lot of the patients, although we're trying through the National Medical Association and the American Academy of Family Physicians. We're making sure that's on the radar of the people in Congress.

MARTIN: Doctors, we need to take a short break. But when we come back, we are going to continue this conversation. We're going to talk about what you hope health-care reform will actually look like. We're speaking with a diverse group of doctors about health-care reform. And our guests are Dr. David Ellington, a family physician in Lexington, Virginia; Dr. Hector Flores, chairman of the family practice department at White Memorial Medical Center in East Los Angeles; and Dr. Carolyn Barley Britton, president of the National Medical Association, who is joining us from Las Vegas. You're listening to TELL ME MORE from NPR News. I'm Michel Martin. Please stay with us.

(Soundbite of music)

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Just ahead, as the latest group of baseball greats are inducted into the baseball hall of fame we talk to the author of a new biography of Satchel Paige, one of the greatest baseball players of all time. And we ask, will he ever get his due?

But first, we're going to continue our conversation about health care from the doctor's perspective. We're joined by Dr. David Ellington, a family physician in Lexington, Virginia; Dr. Hector Flores of the family practice department at White Memorial Medical Center in Los Angeles; and Dr. Carolyn Barley Britton, president of the National Medical Association.

Doctors, I want to play a short clip from President Obama's comments from the town hall meeting - again, last week in Ohio. And he talked about what he thinks health-care reform will look like. Here it is.

President BARACK OBAMA: Medical professionals are free to treat people, not just illnesses. And patients are provided preventive care earlier, like mammograms and physicals, to avert more expensive and invasive treatment later.

MARTIN: Dr. Flores, do you believe that that is possible? And do you believe that that is going to happen?

Dr. FLORES: I do believe it is possible and if nothing else, it's to appeal to our economic self-interest. And that is, that we cannot afford to have the current system continuing. According to the Agency for Health Care Research and Quality, about 10 percent of the population in the U.S. uses 70 percent of the health-care dollars, and it's all around an illness-oriented system of care that has the imbalances between primary care and specialty care. So we're paying for the pound of cure constantly when we could have a wise investment in the ounce of prevention.

MARTIN: Dr. Ellington, would you pick up on that point? You were saying before the break that one of the under-discussed crises, if you will, in health care is that the primary care physician seems to be disappearing. Is that accurate to say or…

Dr. ELLINGTON: I think it's very accurate.

MARTIN: And so, what do you hope health-care reform will look like? What do you hope will be emphasized? It sounds to me like one of your concerns is that one of these critical issues isn't even being addressed in the debate proposals.

Dr. ELLINGTON: Michel, it is being addressed. And the American Academy of Family Physicians has made workforce and pipeline issues an extremely important issue. If I could wave the magic wand and see what it would look like, we would have increased emphasis in payment for primary care medical school education, forgiveness of loans for students who were going into primary care so that we could build the primary care workforce. We would have a primary care and a patient-centered medical home centrality to the whole system so that every patient in America had a primary care physician who was able to manage their care. And then you would have a quality, affordable insurance product that would be available for them so that this would all happen. And I told someone the other day, they said, how will you know when you're getting close to success? I told him, when I stop hearing what's in it for me as an individual or as a special interest group, and what's in it for us as a nation, then I'll think we're pretty close there.

MARTIN: I am interested in what's in it for you, though. Do you think your life will be better under an overhauled system?

Dr. ELLINGTON: Do I think so?

MARTIN: Yeah.

Dr. ELLINGTON: Absolutely. Because the way we're trying to set up the payment issues and the care issues, I'll be paid for taking care of people rather than for doing procedures.

MARTIN: Dr. Britton, I want you to have the last word. And I'd like to know, what would your magic wand conjure up? And I'd also like to know if you think your life as a doctor will be better?

Dr. BRITTON: Oh, I think that what would make doctors' life better is to have a simple administrative process as far payment is concerned. Why you have a thousand different claims to the same office visit claim, I don't know. I think that this is, you know, it's - way out of hand. And a lot of money in health care is wasted on unnecessary administrative duplicative efforts. I agree with what I've just heard before. And so we think universal coverage, combined with a reimbursive methodology that promotes primary care and chronic disease management, is part of the aspect of reform that is necessary because it is incredibly important to produce the type of workforce that can take care of the kinds of problems that you have.

You need workforce diversity, and you need a culturally competent workforce to work with the diverse populations that we're going to have so that you can work on effectiveness in managing problems across diverse populations. Communication is really key. And when you look at many of the African-Americans and Hispanics who come out and you say, where do you want to go practice? They - well, I want to go serve my community. If you go and look and see where they are practicing, you'll find that's in fact what they're doing. They're serving their community. So we would get the nation's needs met by addressing this in the pipeline.

MARTIN: All right, well that's a lot. Do you think - and I'm going to put you on the spot. Dr. Britton, do you think you're going to see this in your lifetime, before you finish your work as a doctor?

Dr. BRITTON: Every day, I'm praying.

(Soundbite of laughter)

Dr. BRITTON: Let me just tell you that. I think this is very important. And people who are opposing this are doing it for no good reason. We don't actually have any other option. We have got to deal with it. And so it's sort of like getting your mammogram. Do you want to know you have cancer today, or do you want to know a year from now? You need to know it at a time you could intervene in a way that makes sense. And I think we have time to intervene in a way that makes sense, and to set up strategic objectives and start working on those goals, and fix it as we go along.

MARTIN: We have to leave it there for now. Dr. Carolyn Barley Britton is president of the National Medical Association. Dr. David Ellington also joined us. He is a family physician in Lexington, Virginia. And Dr. Hector Flores is of the family practice department at White Memorial Medical Center in Los Angeles - was with us also. I thank you all so much, doctors. And I hope we speak again.

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