By Liv Osby
The Greenville News
June 13, 2009
The 64-year-old man with a family history of colon cancer working two jobs has insurance, but can’t afford the co-pays for tests to analyze his rectal bleeding. So he says he’ll wait a year until he’s eligible for Medicare.
Dr. Richard Lucarelli says the solution to this dilemma is a single-payer government health plan that covers everyone.
Dr. John Black says the answer is expanding private insurance to everyone and spreading the risk to make it affordable.
That disagreement is at the heart of the debate over health care reform that began in earnest last week with the introduction of bills to overhaul the system.
Some 47 million Americans are uninsured and millions more have inadequate coverage or go without care because their out-of-pocket costs are too high. Most of them are working.
New research shows that medical bills are implicated in more than 60 percent of bankruptcies and that more than three-quarters of those families were insured.
Experts agree the system needs reform, but are divided over how to do it. And that includes doctors.
Proposed legislation would establish a public insurance plan as an alternative to private insurance, with the government paying health care providers much the way Medicare operates now.
The American Medical Association opposes that idea. Physicians for a National Health Program say that should be the law of the land.
Black, a primary care physician and the newly elected president of the South Carolina Medical Association, says many physicians fear government getting between them and their patients.
In 29 years of practice, he says, he’s watched an easy office visit transform into a Medicare paperwork nightmare that jeopardizes payment if there’s a clerical error.
“That’s a difficult situation when trying to take care of a patient,” he said.
In a letter to SCMA members last week, Black and SCMA board chairman Dr. Gary A. Delaney, wrote that the proposal is “kicking us down the road toward indentured servitude.”
They added that the federal government will dictate which patients to see and which treatments to provide under such a system, and that members should consider measures, short of a strike, to make their concerns known.
“We are sounding the alarm,” he told The Greenville News. “We know things need to be fixed, but if the federal government gets involved, we fear that we will become basically employees of the federal government.”
Lucarelli, a family physician in Duncan and member of PNHP, says that over the past 16 years of practice he’s grown increasingly frustrated by the payment system.
“Patients can’t come to see me because they lack medical insurance and even patients who have insurance can’t afford the deductibles,” he said. “That’s something that most family doctors struggle with on a daily basis.”
Under single-payer, government won’t employ doctors, he said, adding single-payer socializes insurance, not providers.
“That is a misnomer that’s used to scare peopleĆ¢ā¬Ā¦(by) politicians and others with money at stake,” he said. “The government is not going to employ physicians or own hospitals.”