Doctors Weigh-In Renewed Health Care Push

President Barack Obama called yesterday for Congress to make an "up or down vote" on health care, his top agenda item for the past year. He wants the vote to come in the next few weeks and vowed to keep championing reform until the vote comes. Host Michel Martin talks with Dr. David Ellington, a family physician who practices in Lexington, Va., and Dr. Carolyn Barley Britton, who is an assistant professor of clinical Neurology at Columbia University. They discuss what impact a vote on health care means for their patients and their practices.

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MICHEL MARTIN, host:

Im Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, its been a milestone week for gay marriage rights. Yesterday, this nations capital began issuing marriage licenses to same-sex couples. Today, one of Latin Americas most important capitals, Mexico City, legalizes gay marriage and adoption. So well go to Mexico City for a report on how that development is being received there. That in a few minutes.

But first, back to one of this countrys most pressing political and social issues, health care. Tomorrow marks a year since President Obama first kicked off his efforts to overhaul this countrys health care system or at least its health insurance system. Yesterday, he called on Congress to get it done and schedule a final vote.

President BARACK OBAMA: Every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said.

(Soundbite of laughter)

Pres. OBAMA: And just about everybody has said it.

(Soundbite of laughter)

Pres. OBAMA: So now is the time to make a decision about how to finally reform health care so that it works.

MARTIN: We notice that the president surrounded himself with doctors and physician assistants and nurses when he made yesterdays speech. From time to time on this program, weve checked in with a diverse group of doctors to get a sense of what the health debate looks like from their perspective. Among our group are people who take care of patients from all backgrounds - urban, rural, all ethnicities, those with insurance and without.

So back with us today are two of those doctors weve been checking in with. Dr. David Ellington, hes a family physician in Lexington, Virginia. And Dr. Carolyn Barley Britton, shes an associate professor of clinical neurology at Columbia University. Shes also immediate past president of the National Medical Association. I welcome you both back. Thank you so much for joining us again.

Dr. CAROLYN BARLEY BRITTON (Clinical Neurology, Columbia University): Oh, thank you for having me.

Dr. DAVID ELLINGTON (Family Physician): Thank you, Michel. Its nice to be back in touch.

MARTIN: Oh, likewise. So before we jump into the discussion, I just want to play a little bit more about the - from the presidents speech yesterday at the White House. In effect, he was saying enough is enough. Here it is.

Pres. OBAMA: We have debated this issue thoroughly, not just for the past year but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a super majority of 60 votes. And now, it deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the childrens health insurance program, that was used for COBRA, health coverage for the unemployed and, by the way, for both Bush tax cuts. All of which had to pass Congress with nothing more than a simple majority.

MARTIN: So, Dr. Barley Britton, obviously he was talking about the politics of - or the mechanics of how he would wish the Congress to move forward at this point. But I wanted to ask you, do you agree with him on the merit? You just think its time to take a vote on this, move on.

Dr. BRITTON: I completely agree with him on the merit. I actually dont see that any of the discussion that people could have had in the past year has been entirely fruitful, forthcoming or honest. And I think healthy debate and differences of opinion are really part of the fabric of democracy. That is fine.

But this process, early on, was politicized for embarrassment and achieving political gain rather than seeing if it really could be hammered out consensus among competing ideas. And I think that, at this point, for the American people and for health care in general and access to it, we really need to move forward. I just see nothing to gain in starting over, scrapping the bill. We have had this. It will be another decade.

The growth of premium increases is unsustainable. I dont see how individuals or employers can sustain approximate doubling of their insurance rates every three to five years. I think we just are at the brink. And given the recession that we have, if we dont take our steps now, they will not help us. And I just think its do it or suffer the consequences, which I believe to be dire.

MARTIN: Dr. Ellington, what about you?

Dr. ELLINGTON: Well, I agree with many of the things that Dr. Britton said. This has been discussed at length. The question is, is this the best bill that will ever come out for America or is this the best bill right now? We believe that there are so many strong points in this bill that we absolutely need to go ahead and get something passed. And when I say we, Im talking about the American Academy of Family Physicians.

The present situation, as Dr. Britton said, is absolutely unsustainable. And what is not said when we talk about the cost of doing something is the cost of doing nothing. And the cost of doing nothing just cannot continue to exist. In my office, we are seeing more and more and more people that are coming in with a little notation on their charts that say no insurance. And that has really increased significantly in the last five to six months.

MARTIN: In the last five to six months. Thats interesting. Well, youve always, Dr. Ellington, treated both - you have both a rural practice and an urban practice, and you have a clinical practice, as well as a private practice. So youve always had a mix of patients who both have insurance and dont have insurance.

So I wanted to ask, though, obviously youre really busy and youre there to take care of peoples medical issues, but to the degree that this comes up in conversation, do your patients have a sense of urgency about this too because what the Republicans have been saying is that the public is against this at the moment. That theyve changed their minds and they rather that - thats their perspective on this. What are your patients telling you?

Dr. ELLINGTON: Well, my patients dont get into the politics of it, but they get into what affects them. And there are several times, I mean this happened to me yesterday when I would say I believe that you need this test. And they look at me right in the eye and say, doctor, I can't afford this test. And this has tremendous influence on how you treat people.

And Im not talking about some weird test that theyre doing, Im talking about basic blood test to monitor their cholesterol or a basic X-ray. Another interesting thing, Michel, you know, Im the medical director for a local free clinic. And our director told us we are serving 6 percent of the population in our catchment area right now in our free clinic. Six percent of the population comes to the free clinic. This is unsustainable to keep doing this.

MARTIN: If youre just joining us, youre listening to TELL ME MORE from NPR News. Were speaking with a couple of the doctors weve been checking in with throughout the year as the health care debate has worked its way through Congress. Were speaking with doctors Carolyn Barley Britton and Dr. David Ellington.

Dr. Britton what about you? How is the insurance issue playing out in your practice? Youre a specialist.

Dr. BRITTON: Well, I see most of them - my patients mostly have insurance. But what I see are patients whom I havent seen for a while who are going to lose their jobs and lose their insurance. And they will come in - because Im a specialist - and they will come in desperate. I need you to check me out and I need you to get anything that you can get, because Im losing my job on such and such a date or my COBRA is running out at such and such a time.

So people are living with a finite definition to the insurance, and then they have to seek out care now. If they have a chronic problem that needs recurrent care, which is what a number of my patients have, then theyre in trouble because they will fall into the problem where they dont get medication.

I have patients who try to stretch their medications. They dont take medications as their internist provide - prescribed because they are trying to, quote, make it last. If they are in this bridge, where their job is going to go away, they may have unemployment or their unemployment has ended or they can't carry their COBRA because of other expenses or some family stress occurs that none of it is sufficient for them to actually pay their living expenses.

I agree with Dr. Ellington, many people personalize this. And if you go and talk to all the individuals, you find that every individual in the country, the majority will have a health cost story, and so they may not want to get into the politics of this. But we, as a nation, are going to have to stand up and say, we are going to have to move forward.

I think it is significant that the majority of physicians, for the first time, are in support of doing something. We understand that the bill may not be perfect, and there may be other things to do. And theres going to be a time to implementation where the pain is going to continue. So, we understand that. But it really is something that the majority of the physicians are now on board. That has actually never been the case.

So, it means that physicians and patients alike, in their individual office experiences, are sharing an experience about the vagaries of our current health insurance system that directly impacts quality of care and access to care that some of the people in the political part of the spectrum seem to be unaware of or dismissive of.

MARTIN: And thats interesting to me because both of youre reporting that -one of the things that the president said in his speech is that the status quo is unsustainable. And he said that this is something that he feels both parties agree on. And youre both seeing ways in which the status quo is interfering with the kind of care you think is optimal.

So, Dr. Ellington, Im curious, though, why then - Im asking you to speculate - why then you feel that theres still this argument about, you know, start over and start from scratch? Is it that you think that the fear of change overrides the fear of whats going to happen if it doesnt change?

Dr. ELLINGTON: Well, Michel, Ill just take you back to a town hall meeting that I went to for my congressional representative and the degree of misinformation that was voiced on both sides of the conversation to me was fairly astounding.

I think that that in the political process that there is a tremendous amount of misinformation that gets out there. And people are afraid of change. Theyre afraid of losing of what they have. Theyre afraid of the unknown. And they dont understand the implications of what will happen if nothing happens. And no one has really told that story well on the political scene that if you keep it just as it is, this is what will happen.

We cannot sustain a healthy workforce for our economy if we continue doing what were doing right now. And I tried to tell people who say we cant change, we cant change. I tell them, listen, health is absolutely fundamental to the economic power of this country, because you have to have a healthy workforce. And the way were heading right now with our health delivery system, we cant sustain that.

MARTIN: Well, we have to leave it there for now, but we will be checking in with both of you again, and we appreciate your time. Dr David Ellington is a family physician in Lexington, Virginia. He joined us from his office. Dr. Carolyn Barley Britton is associate professor of clinical neurology at Columbia University. Shes also the immediate past president of the National Medical Association. Thats the national association of African-American physicians, and she joined us from her office in New York. And I thank you both again for speaking with us.

Dr. BRITTON: Thank you so much for having me.

Dr. ELLINGTON: Thank you.

MARTIN: Still to come, well talk about how and why the capital of an overwhelmingly Catholic and socially conservative country has now legalized same-sex marriage. That conversation is coming up next on TELL ME MORE from NPR News. Im Michel Martin.

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