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Among Doctors, Many Opinions on Health Care Reform

October 5, 2009 at 12:00 AM EDT
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While President Obama worked to rally doctors around health care reform Monday, fault lines have nevertheless emerged among physicians on topics such as the public option, the role of insurance companies, and the say of patients. A pair of doctors debate their views with Judy Woodruff.

JIM LEHRER: Now, doctors’ views on health reform. The president invited some 150 doctors to the White House Rose Garden today, complete with their white coats, as part of his push for health care reform. They came from all 50 states, and those in attendance were generally supportive. Here is some of what he said to them.

U.S. PRESIDENT BARACK OBAMA: Every one of you here today took an oath when you entered the medical profession. It was not an oath that you would spend a lot time on the phone with insurance companies.

It was not an oath that you would have to turn away patients who you know could use your help. You did not devote your lives to be bean-counters or paper-pushers. You took an oath so that you could heal people. You did it so you could save lives.

The reforms we’re proposing to our health care system will help you live up to that oath. They will make sure …They will make sure that neither some government bureaucrat or insurance company bureaucrat gets between a patient and their doctor. They’ll offer security to those Americans who have insurance and insurance to those who don’t.

JIM LEHRER: Judy Woodruff takes up the discussion from there.

JUDY WOODRUFF: And we get a small sampling of doctors’ opinions. Dr. Hershey Garner is an oncologist in northwest Arkansas where he treats cancer and hospice patients. He’s also a member of Doctors for America, a nonprofit group that backs the president. He met with him today.

And Dr. Donald Palmisano is with the Coalition to Protect Patient Rights, representing physicians opposed to current legislation. He’s a former president of the American Medical Association, but his views do not reflect the position of the AMA, which is broadly supportive of reform.

Both doctors, we appreciate your being with us.

Dr. Garner, I’m going to start with you. We saw you standing right next to the president in that clip just a moment ago. Tell us fundamentally why you think it’s important to reform health care.

DR. HERSHEY GARNER, Doctors for America: Well, it’s a system that’s broken, and it seems to be more broken now than it was 20 years ago when I started doing this. I heard a lot in August about what a terrible thing it would be if we reformed health care and how we’d be putting government between the doctors and the patients. And that has not been my experience at all.

I have patients that can’t get the care they need. They can’t get the studies they need, procedures. And what I’ve seen is that my Medicare patients, I can get studies, I can send them to specialists, I can get procedures I need done. It’s my insurance patients that I can’t get things done. So instead of this mythical government bureaucrat, I have an insurance clerk standing between me and my patient.

And then I heard so much misinformation and fear and anger in the debate in the summer that just prompted me to get involved and at least try to have some sort of civil dialogue about what the critical issues are and to try to help patients.

JUDY WOODRUFF: Dr. Palmisano, hearing that, how are you opposed to health care reform as the president and many Democrats want it?

DR. DONALD PALMISANO, Coalition to Protect Patient Rights: Well, we certainly believe there need to be changes in the current health delivery system. We think medical care here is the best in the world, but we believe that Congress ought to slow down, they’re doing this too fast, and they ought to look at a method that puts the patient in control with the physician as trusted adviser.

As far as the insurance companies, we have some problems with the insurance companies. And those who have so much power in one state, we ought to fix that by allowing people to buy across state lines. We ought to put people in the control of their policy by allowing them to own the policy, give them tax credits, get people off of the system of Medicaid, give them the opportunity to buy an array of insurance choices amongst the insurance companies like the Federal Employees Health Benefit program.

What happens with the government plan is that the government sets the rules of the game. They are the referee in this football game. And at the last minute, they can change the goalpost when you try to kick a field goal, and they will run the private insurers out.

Appetite for a public option

JUDY WOODRUFF: And let me ask you about that, Dr. Garner, because the criticism on the other side is, if you let the government get their foot in the door, they're going to take this thing over.

DR. HERSHEY GARNER: Well, several issues with that. And I get a sense almost of a Chicken Little thing going on. "We can't do this. The sky is falling."

What we don't have is a plan. We haven't been through reconciliation. We don't know what the final plan would be. We know the objectives of the plan.

And it seems to me to suggest that a for-profit, government-run system can't co-exist, FedEx and UPS indicate that probably delivering packages you can run a for-profit and a not-for-profit system pretty well together.

What I don't understand from the folks -- 73 percent of physicians support a robust public option -- what I don't understand from the few that don't is what the insurance industry brings to the mix, why we need to give up 22 percent, 23 percent of our health care dollars for profit and marketing. I don't understand that.

JUDY WOODRUFF: Let me turn to you on that point, Dr. Palmisano.

DR. DONALD PALMISANO: Well, you know, I don't agree with those figures. I don't think the majority of physicians want a public option. Certainly, the public doesn't want it.

And the fact that the government has unlimited resources, they have unlimited taxes, and they don't count in what their administrative cost is, the collection of the taxes and many other things -- and so just look at Medicaid and see the problems in Medicaid. That's a failed system. Look at the public option in Maine, a failed system. Look at Tennessee, a failed option.

And if you go to other countries that have these things, go to Canada, go to Great Britain. I've been to all those countries. I just got back from Australia. What they're doing is giving subsidies to the patients to buy private insurance to get the heat off of the public system.

And so I've practiced since 1970 in private practice, and I can tell you, I've had multiple problems both with the government and with insurance companies, but the key is to put the patient in control, and they can cancel their insurance with one insurer and go to another if they so desire. That gets real competition into the mix.

JUDY WOODRUFF: All right, so he keeps coming back to this point. It should be the individual and not the government.


The patient's role in health care

DR. HERSHEY GARNER: The problem with the discussion we're having is it's not fact-based. We would not map out a plan for taking care of the patient based on some mythical data set. And what he has said is that the Robert Wood Johnson survey of physicians is not correct, that the World Health Organization analysis of our standing in the world community in delivery of health care, that the GAO analysis of what we spend for health care, all of those things aren't right.

What we need to do is have an informed discussion, a debate, not throw out facts that may or may not be correct, but let's look at data that's supplied by objective observers.

JUDY WOODRUFF: And what about -- just very quickly -- his point that it ought to be the individual, that it ought...

DR. DONALD PALMISANO: I would say -- I wrote a book last year called, "On Leadership: Essential Principles for Success." I have a chapter on statistics. And so I would welcome a longer debate with him on your show at some time about the true analysis of statistics.

What you want -- why is everybody afraid of the patient being in control? And nowhere in this legislation is there anything to fix the broken medical liability system.

I mean, it's just -- there's so many details, and we don't even know what the Senate plan is. They're just working with summaries. That would be malpractice in medicine if I said to you, "I'm taking you to the operating room, but I don't know what you've got, and I'm not sure what I'm going to do." I mean, we ought to know what's going on before we vote on something.

JUDY WOODRUFF: It is the case that we are dealing with limited time here, Dr. Garner. But, again, on this point about individuals, I mean, the point that it ought to be tax credits, that it ought to be health medical savings accounts. What about that?

DR. HERSHEY GARNER: The individual is not in control now. The individual's rates can go up. Their deductibles can go up. They can be dropped. Their product can be altered. So the individual is not in control now. But the ones we have in control are people whose primary goal is to turn a profit for their stockholders. And I've got no problem with profits, but I think we ought to profit...

Making insurance more competitive

JUDY WOODRUFF: You're talking about the insurance?

DR. HERSHEY GARNER: Insurance companies and pharma, but a lot of the players are for-profit at the table. But to profit off a person's need seems to me to be unethical and perhaps immoral.

JUDY WOODRUFF: Dr. Palmisano, address his point about the insurance industry. He's now raised it several times.

DR. DONALD PALMISANO: Well, I think the insurance industry, what you do to make them competitive is to get rid of the burdens put on at state and federal levels, let people buy across state lines. Do we have a model for that? The Federal Employees Health Benefit program.

Federal employees, if they don't like the way the insurance company treats them, guess what? They can protest. And, number two, they can change at the enrollment time. That's what we need. We can fix the pre-existing conditions.

There are people in America right now that need help. I get letters every day from people, and we need to address their concerns, but not with more government takeover. The people on Medicaid have insurance, but they don't get medical care all the time because they can't find doctors. They pay less than the cost of delivering the service.


DR. DONALD PALMISANO: The government does.

JUDY WOODRUFF: Do you want to respond?

DR. HERSHEY GARNER: I would like to respond. When you throw out hyperbole, charts, language, government takeover, that frightens people. That's not productive. I think what I don't understand and didn't hear a response to is the 22 percent to 23 percent of every dollar that the insurance companies take out that don't go to health care.

JUDY WOODRUFF: Well, what about the buying across state lines, very quickly?

DR. HERSHEY GARNER: Yes, that is productive. It doesn't address the cost issue, and it doesn't give patients control.

JUDY WOODRUFF: Gentlemen, we could go on at great length. And, unfortunately, we can't do that today. Maybe we can bring the two of you back together to have a further discussion.

DR. DONALD PALMISANO: Sure, I would welcome it. And you are a wonderful moderator. Thank you very much, Judy.

JUDY WOODRUFF: Well, I appreciate that, but we very much appreciate both of you.

DR. DONALD PALMISANO: Thank you. Thank you.

JUDY WOODRUFF: Dr. Palmisano and Dr. Garner, thank you.

DR. HERSHEY GARNER: Thank you. Thank you very much.