Most everyone has an opinion about the health care reforms being debated in Congress.
Here in the Northern San Joaquin Valley, a major overhaul of health care raises questions such as: Are there enough doctors to serve tens of thousands of newly insured patients? Will businesses cave under mandates to provide health benefits? And will the new system better serve patients?
Key provisions of the House of Representatives bill approved this month would require employers to provide insurance for workers or pay a penalty, require individuals to have insurance, and create a government-run plan to help extend coverage to 46 million uninsured Americans.
Everyone from local doctors to business owners and patients will be paying attention as the Senate takes up the issue in coming weeks.
"The public option will provide real competition to private insurers," said Dr. Amarjit Dhaliwal, an oncologist with Valley Cancer Medical Group in Modesto and Turlock. "Right now, you don't have competition."
He is among those doctors who believe the current system, in which a shrinking number of people are insured at ever-increasing cost, cannot be sustained much longer. "The premiums are going up 18 to 23 percent every year," he said. "How are you going to support that model?"
Others contend that extending insurance to nearly all Americans will mean longer wait times for patients.
"If everyone is getting coverage, there is going to be a problem with access to care, simply because of the lack of doctors," said Dr. Michael Cadra, a 56-year-old oral and maxillofacial surgeon in Modesto.
Stanislaus County has 48 medical specialists for every 100,000 patients, while the proportion of doctors to patients is four to five times higher in some Bay Area counties, according to data from the Central Valley Health Policy Institute at California State University, Fresno.
Cadra, who said he plans to practice 14 more years, is concerned that payments from a new government program won't be enough to convince doctors nearing retirement to keep their doors open.
Need for more doctors
And medical training programs are not graduating enough doctors to replace them, he said.
"If we are going to expand access to care, we will have to expand training programs or when my generation starts retiring, we will be in deep trouble," Cadra said.
He believes the Senate should pass legislation with employer and individual mandates, and rules to prevent insurers from denying people based on existing health conditions.
Tort reform, or provisions making it harder for patients to sue physicians, would reduce health care costs, he said. Physicians would order fewer expensive tests and CT scans to protect themselves against lawsuits.
In a county with a jobless rate of more than 15 percent, some worry that a heavy dose of health care reform would stall economic recovery.
"Every time that government mandates something that costs businesses money, it costs us jobs," said Bill Bassitt, chief executive officer of the Stanislaus County Economic Development and Workforce Alliance.
He predicts that, along with the cap-and-trade laws to deal with climate change, a health insurance mandate on employers could decimate valley businesses.
"There seems to be no consideration for what the business impact of these initiatives will be," Bassitt said. "That is what is troubling about them."
Chuck Arnold, co-owner of Phillips Lighting & Home on McHenry Avenue, is concerned about rising health insurance premiums, but would prefer to work within the current system.
Two years ago, the retail business switched to health savings accounts to provide coverage for its employees at about half the cost of conventional plans, he said. It's a type of coverage that allows employees to put money in accounts to pay for health care and invest money left over at year's end.
The retail business could reduce costs if Congress made it legal to sell health insurance across state lines, he said. Current laws prevent Phillips from buying insurance through an industry cooperative.
"Those who want reform point to the tragic exceptions," Arnold said. "Don't destroy a system that is working for the vast majority of people in this country."
Stephen Mort, president of Don's Mobile Glass in Modesto, strongly agrees with the reforms in the House bill. The business provides coverage for its 130 employees.
"I believe there are certain costs of doing business, and that should include health care for employees," he said, adding that the mandate should apply to everyone from the largest to the smallest businesses.
Mort said nothing in the bill would reduce spending on health care, but with more people paying into the system, it could cause monthly premiums to level off.
The valley offers plenty of examples of the health system breaking down for people.
Raymond Vance of Modesto was working as a journeyman carpenter until February, when he was diagnosed with brain cancer and his seizures caused him to stop working, he said.
He is trying to navigate the county indigent health program. With his limited disability income, he said, he can't pay his $538 share of the cost and needs $390 to get his medication from the county pharmacy to control his seizures.
Getting treatment would be easier if he were awarded permanent disability and Medi-Cal benefits, but that decision is months away.
"I need to get these chemotherapy treatments and need to keep taking my seizure medication," said Vance, who is 46. "I would like to see President Obama go up to Canada and see how their health system works. America is falling into the Stone Age."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.