Health Care Debate: The Doctors Check In

The Senate starts debate this week on long-awaited health care legislation. Throughout the year Tell Me More has been checking in with physicians and health professionals to hear what they have to say about health care overhaul. Today we hear from Dr. David Ellington, a family physician in Lexington, Virginia, and Carol Hogue, Professor of Epidemiology and the Director of the Women's and Children's Center at Emory University in Atlanta, about some of the compromises they believe will be needed to get a bill passed.

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MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News. My thanks to Jennifer Ludden for sitting in while I was away.

Coming up, in a few minutes we'll talk about a phenomenon that you might think ended in the Middle Ages but persists to this day, so-called honor killings. The United Nations estimates that some 5,000 women and girls around the world are murdered every year for perceived offences to their family's reputations. Journalist Rana Husseini has been following these stories for years and she tells us what she has learned in her new book, �Murder In the Name of Honor.� And we'll hear about a little known but significant problem in the health care system in this country, so-called frequent flyers. People who frequent emergency rooms for their routine health care. We'll hear how one man became what you might call a gold medal status frequent flyer and we'll hear about what might be done about it.

But first, the health care overhaul debate. The Senate returns from its Thanksgiving recess to take up debate on a major health care overhaul today, following the House, which adopted a bill a few weeks ago after a series of last minute and controversial compromises.

From time to time we've been checking in with a diverse group of physicians and health professionals to hear what they have to say about all this. Joining us today is Dr. David Ellington, who is a family physician in Lexington, Virginia. He treats patients who live both rural and urban areas and has patients who have private insurance and many who do not. He joins us from his office. Also with us is Carol Hogue, she is a professor of epidemiology and the director of the Women's and Children's Center at Emory University in Atlanta, Georgia. I welcome you both, thank you so much for joining us.

Dr. DAVID ELLINGTON (Family physician, Lexington): Happy to be here again Michel.

Professor CAROL HOGUE (Epidemiology, Emory University): Good to talk with you Michel.

MARTIN: So, Dr. Ellington, I'm going to start with you. You've been with us before to tell us about some of the things you think need to change in the health care system. For those who didn't hear those conversations I just want to mention, you pointed out that, one, you told us that this system is totally unsustainable financially. You pointed out that last year the lowest number of American medical school graduates in history went into primary care, which is a serious issue because primary care physicians are often the gatekeepers who care for the whole patient. And, of course, you pointed out that the overall issue of the uninsured, something you see in your clinical practice. Is there anything else that you feel we need to talk about?

Dr. ELLINGTON: Well, Michel, I think as we are getting closer to what we hope is the finish line as far as the primary care services are concerned, we're looking still for increasing payment to primary care services. And really, another big issue is reinvigorating the primary care workforce and realigning the financial incentives. So, we'll get away from just piecemeal care. In other words, paying for this item, paying for that item, paying for this item and trying to incorporate it in more of a global payment system.

MARTIN: So, what I think I hear you saying is that we are focused on paying for procedures as opposed to health�

Dr. ELLINGTON: We are right now, yes.

MARTIN: �overall health of the patient and that's what you think needs to change. Professor Hogue, what about you? What do you - first of all, do you think we need a health care overhaul and what would your priorities be?

Prof. HOGUE: I do think we need a health care overhaul and one of the things that I think is a glaring gap in primary care is that there is no provision in either the House or the Senate bill for well woman care. There is a provision for clinical practices with well baby care and well child care and maternity care but there is nothing in there about well woman care.

MARTIN: And what would that look like? And why do we need well woman care as opposed to well patient care for both men and women? Help me understand.

Prof. HOGUE: Well, that's a start. Women oftentimes are more likely to attend primary care because of need for contraceptives for which - a prescription is required, for care prior to becoming pregnant to make sure that they are healthy. I really have nothing against primary care for men but at the moment the need for prescription contraception is borne only by women. There are no prescription contraceptives that are available for men. And if we are to reduce the number of abortions in this country, if we are to provide for healthy families, we must provide for family planning. And there is nothing in the bill for that except for an expansion of Medicaid services for family planning.

MARTIN: That's interesting, yeah. I want to ask Dr. Ellington, what do you think about that? Has this come up - you're a member of the, make sure I have this right, the American Academy of Family Physicians. Is that something that's come up in your group discussions?

Dr. ELLINGTON: Well, Michel, we're actually going to have a conference call at 9:00 tonight to discuss all the aspects of the Senate bill. Now, part of the Senate bill does include preventative and wellness services and chronic disease management. And that is an item that's in the bill and as Dr. Hogue said, maternity and newborn care is there. Now, I do not have in front of me exactly what the preventative and wellness services entail. So�

MARTIN: Sure.

Dr. ELLINGTON: I really can't comment on whether it includes some of these Dr. Hogue said.

MARTIN: Well, this ties into the issue of abortion, which we were going to get to later. And I - so, we might as well sort of turn to it now. Professor Hogue, what about that? I mean, one of the more controversial aspects of the House passed bill is a restriction on insurance, government insurance coverage for abortions. And as you know, this has become a very big, you know, hot button issue. The House leader said that this was a necessary compromise to get the bill passed. And on the Senate side, many people were saying that this is -there just seemed to be very strong voices on both sides, saying on the one hand they won't pass the bill if it is included, other people saying they won't pass it it's not. What is your take on this?

Prof. HOGUE: My take is that women's health care is being hijacked by the few at both ends of the spectrum who are fighting a battle that doesn't need to be fought. The battle that needs to be fought is the battle over prevention of abortion, which really is the prevention of unwanted pregnancies. And very little is available in either bill for enhancing or even continuing preventive services. There is nothing on explicitly requiring insurance, insurers to cover contraceptive services. There is nothing in there that requires them to cover the total cost of contraceptives. And as a result, women who now have contraceptives covered without cost sharing might have to pay out of their pockets for contraception. The way to prevent abortion is to prevent the pregnancies that are not wanted.

MARTIN: So, Dr. Ellington, is this going to be discussed in the conference call with the family physicians as well, or has your group already taken a position on this question?

Dr. ELLINGTON: Well, I think we're talking about two different issues. One is contraception, one is abortion.

MARTIN: I'm talking about abortion specifically. Because that's - has already been an issue in the House passed bill. It's obviously going to be an issue in the Senate bill as well.

Dr. ELLINGTON: I think that the Dr. Hogue hit the nail on the head is - is this is - this is the subject that we really - this should not stand in the way of health care reform. We have 93,000 members in our organization. And I can tell you that their views on abortion run the whole gamut, from strongly pro-life to strongly pro-abortion.

MARTIN: I think they would say pro-choice.

Dr. ELLINGTON: Pro-choice, yeah.

MARTIN: On abortion, right.

Dr. ELLINGTON: Yeah.

MARTIN: Well�

Dr. ELLINGTON: �and so this is something that I think that you will hear us make a statement on. And it would be a shame if the health care reform floundered on one issue, be it abortion, be it the public option, be it the oversight commission. We need to work on things that we can agree upon and move this forward rather than concentrating on things that we may not have overall agreement on.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. We're checking in with our group of medical professionals to get their take on the ongoing debate over health care overhaul. We're speaking with Dr. David Ellington. He is a family physician. He has a very diverse practice, with both rural and urban, and insured and uninsured patients. And we're speaking with Professor Carol Hogue. She is an epidemiologist, and the director of Women's and Children's Center at Emory University in Atlanta.

And of course, Dr. Ellington your referenced the public option, which is of course one of the other contentious issues, the question of whether the government should have an option for patients who don't have access to private insurance. What is your take on that? The House passed a version of the bill that does include a public option. What do you think? Is this a good idea or not?

Dr. ELLINGTON: Well, the AAFT has been in support of the concept of a public option. And - but not just any public option. We've said that it cannot be - it should not be Medicare for all. Doctors should not be forced to accept the public option or forced to participate in the public option. That it should be actuarially sound, and that the public option ought to go through and adhere to many of the principles of - that the private insurers go to. That it can't be deficit funded like Medicare is right now.

We see the public option as exactly that, an option for someone who cannot get insurance. I just - 20 minutes ago, I just walked through the office talking to a public state employee of the Commonwealth of Virginia, and he said, what do you think about the public option? I'm worried that my employer will drop my insurance and force me into that. I don't think that what it's there for. I told him that I think that public option is there for people who are unable because of finances, pre-existing illnesses, whatever, to buy commercial insurance. And so, we have been supportive of the concept of the public option as long as it meets certain criteria.

MARTIN: And Professor Hogue, final word from you. So many issues to talk about - so little time, I apologize for that. What about you, what's your final thought on that?

Prof. HOGUE: On the�

MARTIN: �public option�

Prof. HOGUE: �public option, I think that this is health insurance reform and that unless the government understands from its own perspective what that requires, that there won't be actual reform. So, I think that the public option is necessary in order for the government to learn what it needs to know to regulate the health insurance industry.

MARTIN: Well, can I ask you, finally professor, are you optimistic or pessimistic about - from where you sit about whether whatever the Senate does, it will address some of the things that you care most about?

Prof. HOGUE: I am not sure it will in this go-around but we have a tendency to pass incremental legislation. And something needs to be passed now, it won't be perfect, but we can work on it in the future.

MARTIN: Carol Hogue is a professor of epidemiology and the director of Women's and Children's Center at Emory University. She joined us from Atlanta. We were pleased to be joined once again by Dr. David Ellington, a family physician, and he joined us on the line from his office in Lexington, Virginia. I thank you both so much for speaking with us.

Dr. ELLINGTON: Thanks.

Prof. HOGUE: My pleasure, Michel.

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