A: Being primary care, we can discount things, we can deal with patients, we can provide them access. What we see a lot of times, though, is if they don't have insurance they don't even try to get that access. They may even roll with that problem for a while and then skip over us completely and then show up in their e mergency rooms, where the care is going to be significantly more expensive and cost us all more money. That is probably the bigger thing. If they've got a $1,500 or a $2,500 deductible, that's almost uninsured to us. That is essentially uninsured when they walk into our office.
Q: Will health care reform go forward after this election?
A: There are so many different angles and avenues. It all comes down to what bureaucracy is set up to implement the bill. For us to tell you how it is going to look is just impossible, because it is going to come down to the implementation of it and the bureaucracy of it. The thing that I was most disappointed with in the bill is that I think we missed a lot of opportunity to try to deal with some of the reasons why health care is so expensive in this country. And those are things you really can't legislate. A lot of different things. One of the most expensive things is patient expectation.
Q: How will the relationship between hospitals and physicians change in the future, particularly under the health care reform?
A: I think we are going to continue to see employment of physicians at a rate that we haven't seen probably in 15-20 years. You're already seeing it now. I think a lot of the physicians that are coming out, if you look and see the last two years, most of the physicians that are coming out are being employed. A lot of that is because the practices are so unsure about things like (Medicare cuts) and the changes that are coming. They don't want to spend that capital to bring in new partners. I think that is going to continue. I think you are going to see collaborations between the hospitals.
Q: How will things change for patients?
A: What everybody always asks is how is this going to affect access to care as this thing moves forward. In the health care bill, it talked about raising Medicaid payments to the level of Medicare. Well, the government is broke, the state government is broke, it is certainly easier to allow Medicare to float down, to meet that requirement for Medicaid to match Medicare as opposed to bring Medicare up. That may be the solution for the government that is broke. That is certainly going to affect all of us, on the margin side. When I say that, on the margin side of being able to sustain ourselves.