My View

I am American with a family that goes back to the 1600s in Staten Island, N.Y. But I have lived in Canada for 30 years where I was both a patient and a doctor. Canada has a government-run, health-care system that provides health care for everyone and allows private insurance policies for bells and whistles.

From my point of view, as a doctor, this is a problem that is long overdue for fixing. I think it is unconscionable that there are people out there who have no insurance and have to be treated at a community hospital emergency room for free (at what cost to the taxpayer?).

I cannot believe when you have the best insurance available that you can still go bankrupt in the United States if you have a serious illness. I also cannot believe that Medicare will not cover many preventive medicine screening tests. I also cannot believe that insurance companies can cherry pick the people they insure, that they can refuse to pay for pre-existing illness and they can drop coverage on patients who are sick and really need their insurance.

This is how Medicare came about for the over-65-age group, a group that had a lot of chronic and acute illnesses, so these people’s insurance coverage couldn’t be dropped. Now we are dealing with similar problems for the under-65-year-old group.

If President Obama and Congress can come up with a way to insure everyone in one way or another and have a public insurance option that competes with private health-insurance company’s premiums, then I am for it, both for patients and for me as a small business owner and employer. It will help to keep my medical insurance premiums down and make it more affordable for my employees to participate.

If the government can attract more generalists (family practice, pediatricians and general internists) into medical training, so people have a “medical home” where preventive medicine is practiced, I am all for it.

The government would do this by helping to keep the cost of training down and rewarding these doctors for practicing good, preventive medicine, keeping people healthy and out of the hospital. Where will it get the money to do this? With reduced tuition for these particular trainees, grants, bursaries and paying specialists less for the aggressive management of disease once it occurs. (Of course this will be fought by specialists tooth and nail.) The turnover of medical priorities might take time, and, during the overlap, it might be costly, but it would put our system back on track for health care rather than sickness care and, over time, it would save money.

Rewarding generalists financially for practicing preventive medicine might help me improve my income; it needs improvement especially because of the seasonal nature of this practice and the economy. The summer months have been grim. Young families are not traveling. Changed reimbursement for generalists might make it easier to find an excellent doctor who has similar skills, to take over this practice when I am ready to retire in six years. There are currently only 95,000 family doctors in the U.S. Only 2% of the graduating physicians are generalists; they are warned to avoid practicing in California and Florida because there are so many patients covered by Medicare that it’s impossible to earn a nice living here.

As always, the devil lies in the details. I am going to pray that the United States will do this and will do it right. It will be a competitive system with options, more people will have access to medical care and wellness will be emphasized. This would put the U.S. much higher in the WHO’s ranking for medical care, rather than the pitiful standing of 37th in the world that it currently holds — with reason. It is an exciting opportunity for all of us, and it will be interesting to see how it plays out.

It is interesting to note, that there has been no mention of tort reform in any of these discussions. That is because most of Congress and our president are lawyers, not doctors.

Do not fall for the rhetoric and buzz words that push your emotional hot buttons such as “socialism” (is Medicare socialist?), “government control,” etc. Remember that the people who have the most to lose are the medical-insurance people, and they will do everything in their power to block these changes. That includes heavy advertising and scare tactics. Talk to me. Ask questions. You are all accomplished and intelligent people. Think of yourselves and vote your conscience. Get in touch with your representatives and senators and express your opinions.

Dr. Pamela J. Letts owns Centre Shops Family Practice and Urgent Care.