Capitol Hill — along with the rest of the nation — is buzzing about health care reform. President Barack Obama wants a sweeping overhaul this year that would extend benefits to millions of uninsured people, and cut spending in the world's costliest health care system. Congressional leaders are drafting proposals and staking out positions on controversial issues like a public insurance option.
We asked people on the front lines of health care in the Tampa Bay area as patients, providers, insurers and advocates what they would tell political leaders if they had five minutes to bend their ears on health care reform.
Dr. Tim P. Carlson
Position: Family practice physician. He runs a primary care practice with Dr. Pedro J. Morales in St. Petersburg with hospital responsibilities, an outpatient office, and service to nursing and adult living facilities.
What he'd say:
• Cost of care hurts patients: "Many of my patients can no longer afford basic health care, medications. They are making judgments now about how to spend their money: Is it the rent, the lights, the transportation? They are sacrificing their own preventive health to live."
• Listen to doctors: "Keep physicians at the table on decisions of quality, not just the legislator, the administrators, academia or business persons."
• Reduce paperwork: Standardized insurance forms, and a transparent and accurate insurance claims process, would let physicians focus on patients.
Situation: A 52-year-old with diabetes and high blood pressure, Santiago has been without insurance for about a year, since she lost her job.
What she'd say:
• We need a safety net: "I've been working since I was 19 and I haven't been without a job. And when I needed assistance, I couldn't find any. This country needs to take care of the people that's been taking care of this country. ... God forbid that your health is worse than mine."
• Re-examine eligibility: Santiago's husband receives about $1,800 a month in Social Security and a small pension, but after paying the essential bills, there's only $50 for groceries for the month. Yet she doesn't qualify for public programs, and she's too young for Medicare. Last week, she went to Tampa's Judeo Christian Health Clinic, a free clinic served by volunteer physicians, after her blood sugar levels had risen dangerously.
• Drugs cost too much: "It doesn't cost $500 to make a pill, and yet some of the drugs I've been on, I've paid as much as $150," she said, adding that now she often goes without needed medication. "Insurance companies, these are legal drug-dealers."
Dr. Carmella Sebastian
Position: Medical officer for insurer Humana's Central and North Florida market.
What she'd say:
• Focus on prevention. "Overall, we have a sick, fat nation that has a lot of chronic illness. That has to be really targeted at both the private- and public-sector levels."
• Everyone needs basic insurance. The costs of emergency treatment for the uninsured are passed on to others in the system, creating a vicious cycle.
• Wake up to the digital age. Health care has lagged behind other industries in adopting electronic records and using the Web to communicate.
Position: President and CEO of Tampa General Hospital, a private not-for-profit hospital that is one of Florida's largest.
What he'd say:
• Reform the legal system. "What happens when you have a litigious society like we have, the doctors have to practice defensive medicine," Hytoff said, noting that malpractice and tort reform is needed. "Patients spend more time in the emergency room. They spend more time in the hospital."
• Look at where care is provided. Reports from Massachusetts, the U.S. leader in universal coverage, suggest that some hospitals are overwhelmed with patients who previously lacked access to care. Reform efforts should consider the impact on hospitals that disproportionately serve the poor.
• Consider technology costs: TGH speeded up its time line to move to electronic health records, as national leaders have encouraged. But Hytoff doesn't know how far federal incentive funds will go toward covering the project's $50 million price tag over the next five years.
Position: Director for AARP Florida, whose members are 50 and older.
What she'd say:
• Create affordable options: "Simply providing access to insurance isn't enough,'' she said. People younger than 64, who don't qualify for Medicare, "need access to plans that they can afford, regardless of age and pre-existing conditions."
• Mind the gap. Many seniors fall into the "doughnut hole" of Medicare prescription drug benefits, but can't afford to pay out of pocket. It's time to close the hole.
•Provide for transitional care: A recent study showed one in five Medicare patients are rehospitalized within a month of discharge. Better care during the transition would address this expensive problem.
Dr. Stephen Klasko
Position: Dean of the College of Medicine at the University of South Florida, and CEO of USF Health
What he'd say:
• Help doctors choose primary care. "You're going to spend billions of dollars to insure everybody, and they'll have no place to go," he said, due to the shortage of primary care physicians. Loan forgiveness and more pay equity could encourage more medical students to go into primary care.
• Acknowledge the hard choices. "The problem is under our system, everyone has incentives to do more and more," Klasko said, noting that the bulk of medical expenses are generated in a patient's final months of life. Bottom line: We can't achieve health care reform without giving up at least some of that care.
• Get serious about information technology. Electronic records and prescriptions can curb drug errors and help coordinate treatment. There's no reason for doctors not to use e-prescriptions, he said.
Times researcher Will Gorham contributed to this report. Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322. For more health news, visit www.tampabay.com/health .