WASILLA �” On Tuesday night, a panel of seven Alaska doctors fielded questions about what the proposed changes to the health care system would mean for their profession.

“We want to hear how it will affect (their) practice, patient care and privacy issues for the people,” Jenny Bettine said before the meeting. Bettine is the president of the Conservative Patriots Group, the organization that hosted the meeting. “We feel like they have been ignored.”

The goal is to be better informed for Sen. Lisa Murkowski’s town hall meeting today, Bettine said. She said the doctors were not given any questions in advance and audience members were not instructed to ask any specific questions. CPG asked doctors to volunteer for the forum, she said. Many more responded, but the forum only had time to hear from seven. “This is not canned in any way,” Bettine said. “We want this to be a town hall of doctors who want to present information, and we need the information.”

Talk show host Glen Biegel moderated the discussion and began the questioning by asking how covering the “alleged” 47 million uninsured would change the doctors’ practice.

Dr. Wade Erickson, a family practitioner, began by saying this would increase the need for primary care doctors, but primary care residencies are about half as full as the once were. The larger volume of patients with the shortage of primary care doctors would lead to reduced quality of care, he said.

“We as a country are not ready for that influx of patients,” Erickson said.

Biegel responded by saying those without insurance go straight to the emergency room, driving up costs. Isn’t goal of universal coverage is to lower these costs, he asked.

Erickson said his practice loses money with each patient whose care is reimbursed by the government. More government programs equals more money lost, he said.

“The problem is not solved but compounded” with the new plan, Erickson said.

Dr. Doug Vermillion, and orthopedic surgeon, said the military health care system is being proposed as a model for the new reforms. After serving 21 years in the Army, he is familiar with the system there, and the often six-month delays that come with it.

“Slavery was abolished in 1865. I’m not going to be a slave to the government. I’ve already served my time,” Vermillion said.

When Biegel asked how many patients each doctor sees every day, the consensus around the panel was 20 to 25. Dr. John Boston, an internal medicine doctor, said when he worked in Detroit a bell would ring every seven and a half minutes. At that time, doctors were supposed to move on to the next patient.

Dr. Greg Lund, a urologist, said the concept of universal health care appeals as a good goal, but the problems come from the complexities of getting there. The Medicare system is going broke, he said, and he only gets reimbursed 20 cents on the dollar when dealing with Medicare or Medicaid.

Lund said, “45 percent of what I bill is to Medicare, and that accounts for only 15 percent of my reimbursement.”

Thinking they can come up with a public plan that can break even is ludicrous, Lund said.

“The bottom line is you can’t pay for this ... unless you increase taxes, cut reimbursements, print more money or borrow more money,” Dr. Tom Grissom said.

All the talk about saving money by reducing sham surgeries and unnecessary procedures is insulting, Grissom said. People enter medicine because they have a passion for it, he said.

“If you take that away, you’ll find a lot of doctors doing medical missionary work because they want to do something worthwhile,” Grissom said. “There will be a lot of physicians who decide they are just done.”

Vermillion pointed to California. The government there has run businesses out of the state.

“I think this whole thing will gut the country,” he said to the audience’s loud applause.

The doctors then responded to a question about the cost of dealing with the required paper work.

Boston said in his office of three, one and a half employees do nothing but paper work. Erickson said the cost is tremendous and explained about a new program in Medicare called “Pay for Performance.” Doctors can increase their reimbursement rates by 1.5 percent, but the extra paperwork to meet the requirement would require an additional 10 percent in administrative costs, he said.

Not one doctor participated in the program.

Grissom said his practice in Idaho had 27 employees, six handled the billing and two did nothing but make sure all the requirements were satisfied. The Feds hold a big sledge hammer over your head, he said, as each claim of inaccuracy can come with a $10,000 fine.

Chiropractor Tyan Payne said the paperwork requirements are nothing short of ridiculous, and the process of appealing a claim made against your practice is talking to a computer.

A bigger government program “would stifle your ability to function,” Payne said.

Grissom added that, during the Clinton Administration, for every $1 million spent investigating physician fraud, the government saw a $9 million return.

This doesn’t represent a huge amount of fraud, he said, “it represents physicians unwilling to fight the claims made against them. The government is not something we like to deal with.”

The focus then shifted to patient privacy. An audience member was worried about his medical records but understood physicians have to share information.

It’s hard to criticize one bill because they are changing so frequently, Grissom said, but the bill that made it through the House of Representatives gives the secretary overseeing health care the power to determine what information can be seen. This secretary is above judicial review, he said, and the bill opens up patients’ tax records, income records, employment history, credit report and whatever else the secretary deems worthwhile. Reforms are needed, he said, but not the ones being proposed.

“Can physicians get involved to help control costs? Absolutely. But it comes from a local review, not the federal level,” Grissom said.

Payne said her field focuses on preventative care. They give people instructions to follow, but it’s up to the patient to follow them, she said.

“Personal responsibility gives us personal freedom,” Payne said.

Surgeon Brent Taylor said America needs to decide if health care is a right or a privilege. Once we solve that debate, he said, then we can move forward.

Lund added that health care is a right under the current system with the Emergency Medical Treatment and Labor Act. EMTALA guarantees care to people who have an emergency or are in labor despite the fact that health care shouldn’t be a right, he said.

The key to health care reform, Lund said, is tort reform.

Without limiting doctors’ liability for poor outcomes, physicians are forced to practice defensive medicine, he said. For example, if you come into an office with a headache, you will get a CAT scan.

“Very few doctors will use a little common sense because they are so afraid of the consequences,” Lund said.

Taylor added physician retention is higher in areas where tort reform is in place, and Boston said it is no wonder why fewer young men and women come to his office asking about the future of medicine.

Defensive medicine accounts for 25 percent of health care costs, Lund said, and President Obama stood in front of the American Medical Association and said tort reform is off the table.

“All of us would admit there does need to be reform, but all the cards have to be on the table,” Lund said. “To take tort reform off is intellectually dishonest.”

Erickson said the real problem is we have moved away from personal responsibility for health care costs. We now think our insurance plan dictates what we can and cannot do. Insurance is not meant to pay for your entire costs, he said. Rather, it should be used for emergency-type things.

Grissom agreed the reform needs to start with the individual. We are a debtor society, he said, and have created a society of entitlement.

“People expect something without accepting the responsibility that comes with it,” he said.

Contact Todd L. Disher at todd.disher@frontiersman.com or 352-2252.