Nevada County Picayune and Gurdon Times Newspaper Archive

Local doctors agree medical profession is in trouble

Health care in its current incarnation will not survive, according to Prescott's three doctors.

The trio of physicians, Dr. Alan Fox, Dr. Charles Vermont and Dr. Mike Young, agreed major changes need to be made in health care on a national level if it is to survive.

All three said the biggest problem is insurance costs  not only for the patients, but the doctors themselves.

However, Vermont said there are good things going on in health care as well, especially locally.

There are three full-service clinics in Prescott and the general health needs of Nevada County residents are being met, he said.

Fox said a "crowning jewels" occurred year. The passage of the medical liability reform act by the state legislature.

Currently, he said, nursing homes don't tend to have insurance. The way the law was before the act passed was if a nursing home was sued, the plaintiff also sued the doctor, who was insured, with the doctor being liable for the entire settlement.

Now, if a nursing home is successfully sued, it is turned over to the plaintiff, while the doctor is not involved.

Young touted changes in medical technology over the past 28 years as being the best thing to happen to the profession.

Twenty-eight years ago, he said, the first room for a Cat scan was being built in Arkansas. This was a new technology few had heard of. Now, CT scans and MRIs are routine procedures readily available.

But, all three agreed medicine's biggest problem is insurance companies.

Vermont said it's difficult for doctors to find companies willing to offer malpractice insurance, and those offering it charge exorbitant rates for the coverage.

Historically, Young said, medical costs have shifted from the uninsured or under-insured to third party insurance, but there has never been free health care.

In Nevada County, he said, most of the under-insured have Medicare or Medicaid, and this amounts to 71 percent of the patients seen.

Young was the most outspoken on the insurance problem, saying the days of cost shifting have ended, and a large part of medical budgets going for insurance coverage while reimbursement declines.

"The medical system in the United States will crumble and die," he said, "and have to be reborn."

Young praised the Clinton Administration for making the attempt to change the medical profession and for the changes it managed to make.

But, he said, the entire system must change for basic health care delivery and reimbursement.

One of the biggest problems, according to Young, is those who have no insurance tend to go to hospital emergency rooms for their medical care, and, in many instances, aren't able to pay. This results in the costs being passed to those who can pay.

"People without insurance," he said, "have their medical needs not met, or go to the emergency rooms for non-emergency needs. There are flaws in the system.

"Today insurance companies rule the world and decide what does or does not get paid. Now, it's all about coverage. Insurance companies don't care about people, but their bottom line profit and keeping the shareholders happy."

People in the U.S., Young said, pay more for the same medications than people in Mexico and Canada. In most instances, these medicines are manufactured in America.

The current trend, according to Vermont, is toward HMO and PPO coverage for people and more coverage for those living in urban areas.

But, when it gets to rural areas with individuals medical practitioners, nursing homes and ambulance services, he said, there are more regulations to be met than ever before.

This results in doctors having to spend more time doing paperwork, instead of seeing their patients.

"Instead of doctors or paramedics," Vermont said, "we have to become business people. Most doctors aren't trained for it, and it'll be hard to get doctors to come to small towns because of it."

He said the problems cause constant pressure and frustration for those involved in the medical profession because they have to deal with people who don't know what's going on, aren't here and don't care. In addition, those people won't handle the problems themselves.

For Prescott residents, he said, the future may be to look at what's normally called the "hospital tax" and use it for health care.

"Prescott is a tough duty station," Vermont said. "Doctors have to handle everything and be available to patients. It would be nice to have an urgent care center and an after hours clinic."

According to Vermont, the Nevada County Hospital closed in 1995 because of reimbursement problems.

Fox said a problem with small hospitals is turnover. At Medical Park Hospital in Hope over the last five years, there has been a 50 percent turnover rate for physicians.

Nevada County is designated as a rural health shortage county, he said. "I don't see how we could support another health care facility."

Smoking, according to Fox, is one of the biggest issues locally, but, he added, there are programs to help people quit.

About 50 percent of adults in Prescott, he said, are smokers.

Smoking, Fox added, has a direct impact on the cost of health care because smokers tend to have more health problems.

Vermont said the out-of-pocket expense for health care in the county has gone up because many people don't or won't take advantage of the services offered locally and travel for their medical care.

Travel is also a problem for doctors, Fox said, as many debate over whether or not they want to be affiliated with a hospital because of the time it takes.

Insurance companies, Young said, have doctors where they want them, because the companies require doctors to be affiliated with hospitals.

"I'm like Dr. Fox when I look at the time and money involved," Young said. "There's a lot of economics involved in medicine, and I spend about six hours a day driving to and from Hope."

Fox pointed out there is no urgent care center in Hope, either, though MPH does have an emergency room for after hour care.

Another problem, Fox said, is there are facilities no longer accepting Medicare or Medicaid because of the reimbursement problems with the government.

"I think we'll have socialized medicine," Fox said. "We haven't reached a crisis yet, but the number of uninsured continues to rise."