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A doctor's view of health care reform

A doctor cares for a patient at a hospital in Panorama City, Calif.

TEXT OF STORY

Steve Chiotakis: Today, we're expecting to get a long-awaited Senate version of the health care reform bill. Senate Finance Committee Chairman Max Baucus is set to unveil an $880 billion
proposal that so far doesn't have any Republican backing.

And while the health care debate is very partisan, there's seems to be consensus that something needs to be done to address it. This week, we're looking at some of the biggest stakeholders in the health care overhaul. It's part of the series The Cure," our continuing coverage on the remaking of health care in America. Today we check in with doctors. Jill Barshay reports.


Jill Barshay: Neil Calman practices family medicine in New York. For 32 years, he's been seeing patients for check-ups, flus, colds, and a lot of diabetes. Like other primary care doctors, he gets paid per office visit.

Neil Calman: So imagine that you're basically getting paid, you know, $20 an hour -- which is less than what we pay our nurses.

Dr. Calman wants to be paid more. And the health care bills in Washington would boost fees for primary care doctors by a small amount. But what Dr. Calman really wants is for the government to step in and use its purse to promote preventive care for patients.

Calman: Really helping them lead healthier lifestyles so that they can prevent the kind of illnesses that really are preventable.

But if primary care costs go up, the money is going to have to come from somewhere. And specialists like Dr. Robert Vogelzang are worried they'll be targeted for cuts.

Dr. Vogelzang is an interventional radiologist. He works with catheters and CT-scans to treat diseases that might otherwise require open surgery.

Dr. Vogelzang: We're the people who invented angioplasty and stenting.

Unlike Dr. Calman, Dr. Vogelzang can earn $1,200 for a procedure that lasts an hour and a half. His big concern is that if the government gets involved in the health care system, medical procedures will be judged by what they cost.

Vogelzang: And what would happen if you define effectiveness in a narrow cost-constrained manner, we may not pass that metric.

Vogelzang worries that Washington might drive private insurers to cut back coverage for his innovative procedures. And his specialty -- along with his income -- will decline.

Paul Ginsburg is a health economist:

Paul Ginsburg: There's always been an issue with physicians and health care reform. Because health care reform has the upside for them that more of their patients will be able to pay their bill because they'll have health insurance. But they've often been concerned about the level of government control that might come with it.

Ginsburg says doctors are likely to remain divided as the health care debate continues.

In New York, I'm Jill Barshay for Marketplace.

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Can't believe you didn't use the JAMA poll in your story on "doctor's think..." as it surprisingly showed that from 63 - 73% of docs support a public option. You also didn't follow up with the specialist to ask if he is happy with insurance bureaucrats telling him what to do as opposed to "government". You also failed to point out that there is no "government run" option on the table -- only a public-funded option which is paid to PRIVATE providers. I'm tired of your wuick & shallow coverage.

Your story on doctors' opinions about health care reform, specifically their reimbursement, somehow missed the elephant in the room. Primary care doctors are the lowest-paid of all physicians: family medicine physicians are paid a median $145,000 per year [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/gradu..., while interventional radiologists make nearly 3 times as much, at $410,000 [http://www.rsna.org/publications/rsnanews/oct04/salary-1.html]. This mirrors the income disparity in American society at large. Health care reform would indeed do well to reduce this disparity. Interventional radiologists need not fear procedures being denied to patients under health care reform, but in fairness they should expect an end to this lavish payment by a system that overvalues medical procedures and undervalues human contact.
FULL DISCLOSURE: I am a practicing primary care pediatrician.

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