As the national health care debate continues, arguments have contrasted starkly. But amid the rising tensions, doctors have increasingly been caught in a no man's land of health care reform. Most health care professionals will agree that the something must change, but they are also quick to point out a lack of understanding on both sides, alongside an oversimplifications of a complex system.
However, health care options are important. They affect 100 percent of the population at some point. And health care experts, whether they are doctors or administrators, have their own views of how reforms should be introduced.
"I would like to see more availability for physicians to be trained," said Jeff Manley, CEO of CastleView Hospital in Price. "The president wants to add 46 million people to a system that's already short on physicians. One of his problems is that he's not defining things very clearly."
Numerous options for reform are being considered, but few compromises are being reached and with no end in sight, the debate continues. Some core arguments revolve around expenses and availability. These two aspects have proven to be difficult issues, because they directly affect each other. One of the current system's strengths is its availability. Quality care might be expensive, but it is generally available on demand.
"We should not compromise quality of care," said Dr. Ateeq Ahmed S. Patel. "Things should not just be changed, but improved."
Rising expenses manifest a major problem facing the current system. Some increases can be explained by advances in technology, while others relate more closely to the types of lives individuals lead. It is a fact that people are living longer, but not necessarily healthier, this has, in turn, forced people to seek more expensive emergency treatments as opposed to cheaper long term preventive measures.
"It's a (complex) combination; people are living longer, but also the Baby Boom generation is having (new) medical problems. Most of these diseases didn't exist before, because people didn't live long enough to get them." said Dr. David Rawling, a cardiologist from Salt Lake City.
The average life expectancy in the United States in 1909 was about 50 years old. Presently the average is around 78 years of age. With an entire segment of the population living to an advanced age, medical science has been in uncharted waters.
Technology, on the other hand, has also advanced steadily alongside costs, but in some cases, improved technology has lowered costs. Twenty years ago, according to Dr. Rawling, CAT scans would require the hospital CEO's approval. Today, they're a standard weekly procedure. Other items, however, incur added costs. For instance, operating techniques that leave fewer scars, while cosmetically more attractive, cost significantly more. Medical equipment is another big ticket item, because hospitals frequently pay millions of dollars for a single machine.
"Many pieces of equipment are [priced at] over a million dollars. A new MRI machine costs around $1.5 million." said Manley.
Costs are a big issue, but, in Carbon County, only about 10 percent of the population pays out of pocket for treatments. While this number is low, those who are insured also face increasing rates.
"A lot of people who are uninsured, fall into two groups," said Dr. Rawling. "Young people who are in good health, who hope nothing happens, and the self-employed, or small business people who can't provide it. My office does not provide insurance (for the employees), but we give our employees extra money for it."
The type of insurance that should be offered --either public or private-- is a major talking point in Washington. In the world of working medicine, opinions still contrast.
"I would go for a single payer program for a couple of reasons; for one, there are high administrative burdens, some people are making huge amounts of money and two, with Medicare, it has been in place to prevent the rapid rise of prices (on things like pacemakers and drugs)" said Dr. Rawling.
However, Manley was more in favor of a private system on the basis of bureaucracy.
"Cons to a public system are that they're run by the government, with a huge bureaucracy," said Manley. "A (national) system would add a lot of agencies. I don't think the government can do it better than private. My biggest concern is that they're rushing to get it done and missing some key information."
Nonprofits are another option for insurance, because they offer a private option, but without overhead costs. Dr. Rawling said that, from his point of view, such an option would be ideal. Manley said he was mostly concerned about increased regulations, because he indicated there are already a lot and the proposed health care bill is over 1,000 pages long.
Along with insurance, legal issues on claims often arise. One of the main legal problems concerning health care is malpractice lawsuits. Tort reform is an issue that has the potential to lower costs, but it also ties in with other areas that need reform.
"I think (tort reform) would slow the increases of prices," said Manley. "Some other states have it and I know Utah has talked about it."
Doctors' fear of being accused of malpractice often drives up costs more than the actual lawsuits, because defensive medicine must be exercised. Defensive medicine takes place when a doctor takes additional steps to make sure a diagnosis will hold up in court. Although reforms in this area vary from state to state, most doctors agree they are needed.
"Some sort of cap on damages would be nice. Even if these cases don't go to court, you still have to deal with an attorney," said Dr. Rawling.
In all, because the debate covers a vast arrangement of issues and problems, but with an uncertain outcome, health care reform might be a ways off. Everyone interviewed for this story indicated that lawmakers need to analyze the information carefully and make sound decisions, not across party lines, but in consideration of what is best for the country.
"First, you need to analyze the problems, then you must study the issues. We need a comprehensive vision of what is to be done. Healthcare is not to be diluted," said Dr. Patel.