Doctors Think Differently About the New Health Care Law

March 23, 2010— -- Dr. Lee Green, a primary care physician in Michigan, was seeing patients in his office late today and telling us why he thinks having millions more people covered by health insurance will help frontline doctors like him prevent more serious illnesses down the line.

"There are a lot of folks out there who will be coming in more regularly, they'll be able to be treated and I'll be able to provide care for them early," he said.

Meanwhile, in Atlanta, Dr. Wendy Wright, an intensive care neurologist, was checking in on a patient who just had brain surgery, and telling us that with so much money about to be poured into primary care, she's worried resources will be taken away from the kind of high-priced, super-specialized care she provides.

"People will die," she said. "And these are the people that I have to face every day and I'm going to have to be the one to tell their families 'I'm sorry I'm not allowed to do that for your child, I'm not the one who can save your husband.'"

With the new bill, Wright said, "the government ... will be in charge of the purse strings, and will therefore get to decide what procedures will be reimbursed."

Yet, she said, "No legal protection is provided to physicians who may not be allowed from an administrative standpoint to not provide any and all measure of care due to cost-containment measures. This is obviously unsustainable."

But Green disagreed.

"I think that's very unlikely," he said. "I don't think people who need care will not get it."

But, he said, "The upside is the downside: [The bill] will -- once phased in, not immediately -- increase visits by the unemployed, part-time workers, and people employed in jobs with no health benefits. That's good, because my patients who need care will be more likely to get it.

"We will, for example, see fewer cases of heart failure because we'll get people's high blood pressure taken care of before it causes heart failure," he said.

One thing the doctors did agree on was that with millions of newly insured people flooding into the system in roughly four years, there's a looming question: Who will provide all of them with primary care?

"There are too few of us," Green said. "We were already short-handed and now we have 32 million more people who are going to be coming into the system."

The reason there is such a shortage of primary care physicians already is that many young doctors opt for more lucrative, higher-prestige specialties like surgery or dermatology.

Massachusetts illustrates the shortage; health care reform passed in that state in 2006 but the new patient wait to see a primary care physician is 44 days, the longest in the nation.

The new law does try to encourage doctors to go into primary care by giving them some bonuses and even helping with their student loans.

But some experts are not sure that will be enough to get more people into primary care.

"It's a beginning," said Dr. Louis W. Sullivan, chairman of the Sullivan Alliance in Washington, D.C., and a former secretary of Health and Human Services. "But this is really just a fraction of what is needed."

He said that we need a national effort, like the Manhattan Project, to get more doctors into primary care. It's been done before, he said.

In the 1950s, facing a doctor shortage, Congress funded many new medical schools, doubling the number of doctors.

But right now, he said, the government is "missing in action."