Will it help or hurt? Five faces of the health care debate

Doreen Case has her vital signs checked by Dr. Steve Sainsbury at her San Luis Obispo home.
Photo by Joe Johnston 10-13-09
Doreen Case has her vital signs checked by Dr. Steve Sainsbury at her San Luis Obispo home. Photo by Joe Johnston 10-13-09 Tribune

While lawmakers move closer to a compromise on health-care legislation, San Luis Obispo County residents continue to debate what shape reform will take and how it will affect their lives.

Local business owners, faced with higher premiums, worry that the new requirements will saddle them with additional costs. Seniors fear that Medicare will be cut. Those with no coverage hope changes will make doctor visits more affordable for them and their families.

Still others are afraid to speak openly about such a hot-button topic or remain unconvinced that reform is needed.

What is not in dispute, however, are the statistics.

Nearly 37,000 local residents, or about 14 percent of the county’s population, are uninsured, according to the U.S. Census Bureau’s 2008 American Community Survey, the latest data from the agency. More than 5,000 people under the age of 18 lack health insurance in the county. The majority without insurance — more than 31,000 — are between the ages of 18 and 64.

In California, the number of people without health insurance is estimated to be more than 6.4 million, or nearly 18 percent of the population. The national figure is estimated to be more than 45 million, or about 15 percent of the population.

Rising health-insurance costs are contributing to the loss of employer-sponsored health care coverage. And the ailing economy has only made things worse, with an estimated 3.7 million working-age adults becoming uninsured nationwide and half a million losing coverage in California alone over the course of the recession, say experts with the UC Berkeley Center for Labor Research and Education.

Researchers there predict that the number of those without coverage will grow even in a full economic recovery.

Without health insurance, many families are left with no safety net, the “financial peace in a time that may be fraught with anxiety,” said Kena Burke, executive director of the Children’s Health Initiative of San Luis Obispo County.

“It’s that unexpected lump in a breast or an emergency room visit at 3 in the morning,’’ Burke explained. “An insurance card allows you to have choices for specialty care, therapy and many things that the uninsured must choose to pay for at costs that may be prohibitive.”

The Tribune spoke with five local residents — an emergency room physician, Cuesta College student, father of two, the chief executive officer of a local company and Medicare recipient — willing to share their thoughts on the path the nation should or should not take to solve this complex issue.

The Medicare recipient: No faith in a government-run health care plan

Doreen Case is adamant that a government-controlled health care plan is not the answer.

“Until they get rid of the government-run part of it, it is not going to work,” the San Luis Obispo resident said.

She worries the government is trying to “ram down our throats what they think we should have.”

But she has had good luck using Medicare and a Medicare supplement health plan offered through the California Public Employees’ Retirement System. Both are available because her late husband was a Caltrans engineer.

She also buys long-term-care insurance for $416 a month. It’s something she will not forgo because it worked out so well when her husband’s health declined. She explained that she spends more each month on insurance than many she knows, all so she has that protection.

Case said all of the bills being proposed by Democrats do not take care of the lack of doctors, or the fact that doctors are dropping out of Medicare.

“There will be committees telling people what to do, not just old people, but people like my daughter, who has lupus,” she said. “They say you’ll get your own doctor, but you won’t get your own doctor. You won’t get your own insurance plan.”

She acknowledges that something could be done about those who are uninsured, like setting up clinics where they can get health care beyond the expensive treatment they receive in emergency rooms. But changing the entire system to a government-run one because of that 20 percent of the population without insurance will not work, she believes.

“The government can’t even run the post office,” she said.

The emergency room doctor: Believes a switch to universal health care is inevitable

Health care is a right, not a privilege, and if the U.S. doesn’t figure out a way to provide it now, it will have to do so later.

So says Dr. Larry Foreman, an emergency room physician from Arroyo Grande, noting that he does not speak for his colleagues or his employer.

As an ER doctor working “in the trenches,” Foreman says he sees the most basic level of human needs — patients from birth to older than 100 with maladies from simple anxiety to heart attacks. While some patients — with or without insurance — don’t worry about that, there are others who can slip through “huge cracks in the floor.”

For many, “it’s time-consuming, it’s frustrating, and expensive,” he says.

For a doctor making decisions on what to treat and what not to treat, “the pen … becomes a lethal weapon,” he says.

“We can do it now, or we can do it later,” Foreman says of universal health care. The current system is destined to “implode,” he says. “It’s not sustainable.”

Demographics are not reassuring, he says. Technology is improving, but it’s expensive, and people are living longer.

As to arguments about what he calls “the R word” — rationing — Foreman says the current system already rations health care.

People sign “do not resuscitate” orders, doctors routinely talk with patients and families about end-of-life decisions, and hospices exist to help patients through the final days and weeks, he notes.

All that is going to continue and intensify, Foreman says.

The ideal system, Foreman says, would provide “the best result with the least amount of money being spent,” as opposed to the market deciding, which he believes is the way health care delivery works today.

As to spending less money, many reforms are needed, including making sure pharmaceutical companies spend their research and development money on research and development and not on salaries and advertising.

Foreman also stresses the need for preventive medicine, including vaccinations. “Do you have any idea how much money (flu vaccine) saves us as a society?”

The college student: Says anything close to socialized medicine is ‘a terrible idea’

Cuesta College student Marriah Smith believes there are problems with the current health-care system. But the 19-year-old animal science major says Congress is approaching reform the wrong way.

The proposals on the table would not be deficit-neutral but would add to the nation’s mounting debt and increase taxes, she said. Congress should work with health insurance companies to reduce costs and focus on tort reform, which she believes will lower health care costs by pushing down medical malpractice costs for doctors.

Moreover, if having health insurance became a requirement, many young adults would not sign up for it, she explained.

“They would rather pay a fine if the fine is cheaper,’’ Smith said. “If they’re healthy, they would say, ‘Oh, I’m not going to need health insurance.’ ”

But what Smith opposes most is government-controlled health care. She is against socialized medicine, saying that “anything near it is a terrible idea.”

“I know people from Canada who come here for health care,’’ said Smith, who has coverage through her father’s HMO plan.

However, Smith, who has health problems herself, said those who face hefty medical bills should get some relief.

“I get migraine headaches. … I’ve been getting them my whole life,” she said. “To this day, doctors don’t know what my problems are because my health insurance won’t cover the specialist I need to see.”

But Smith added: “Don’t get me wrong, I’m not saying our health care system is great, but we’re definitely better off than a lot of other people are.”

The single father: Needs health insurance for his two children

Desert Storm veteran Keoni De La Cruz still hopes that he can get health insurance for his children, who are 5 and 10 and attending school in Atascadero.

But it hasn’t been easy for the 39-year-old security supervisor.

De La Cruz, recently divorced, says he has been shunted from would-be provider to would-be provider, growing ever more entangled in red tape. He is currently, as he puts it, “sitting in limbo,” with his children going uninsured for six months.

De La Cruz and his wife divorced in April. They have joint custody of the children. She had coverage for the kids, but lost her job. She cannot get coverage for the children at her new job because she works in a private home. De La Cruz’s job does not include health insurance benefits.

De La Cruz is a veteran, but that doesn’t help his children, he says.

Still, he continues to fill out paperwork, providing birth certificates and otherwise seeking to prove that his children deserve to be covered if they get sick.

So far they have remained generally healthy, De La Cruz says. But his son has an eye condition and needs surgery at some point. He can’t afford it.

He is pinning his hopes on the Healthy Families program, which provides low-cost insurance to children whose parents work but cannot afford insurance on the private market.

The program is experiencing record demand as more and more families lose health coverage in the ailing economy. But the state reduced funding for that program this year.

De La Cruz recognizes that he’s just one of thousands of parents who face similar dilemmas. He is not sure what to do about that.

“I think there’s a fix,” he says. “Just so long as everybody is covered.”

The human resources executive: Wants to see a plan that helps contain costs

As co-CEO of Your People Professionals, Sandra Dickerson helps small-to-medium-size businesses provide human resource services, ranging from performance evaluations to payroll services and health insurance administration.

Dickerson said her local clients, whose employees range from one to 150, are wondering how health care reform will affect their bottom line.

“There’s concern and confusion,’’ said Dickerson, whose firm is based in Santa Maria with locations in San Luis Obispo and San Francisco. “There are so many different bills and ideas being thrown around. It’s very difficult to weed through those and get a good idea of what might be serious proposals or things that might not go anywhere. We’re all waiting to see some solid ideas.”

Right now, proposals include requiring medium-to-large-size employers to offer health insurance to their employees or pay a fee to expand coverage. Small businesses with payrolls below $250,000 would be exempt. Some small firms (those employing fewer than 50 workers and with an annual average wage of less than $50,000 according to a Senate Health Education Labor and Pensions Committee bill) also would be able to buy insurance through a so-called “insurance exchange” and would be eligible to take advantage of a tax credit.

While Dickerson believes reform is needed, she said that it should be “solid reform” that will help employers manage costs. Health insurance costs to employers have increased about 10 percent to 15 percent annually, Dickerson noted. Some businesses, especially those squeezed by the recession, have stopped paying 100 percent of employee costs or shifted to plans that require employees to share more of the burden.

“It’s just not what employees pay but what employers pay in premiums,” she said. “We have to get that better managed.”