Editor's note: This fall, The N&O is talking to people about the nation's health-care system: what works, what doesn't and what should be done to fix it.
After 18 years as an insurance executive, Ron Howrigon decided to leave the business the night his son was born.
It was late, and the delivery doctor, whose salary Howrigon had worked to undercut in negotiations for his insurance company employer, finally performed a Caesarean section birth. As Howrigon thanked him, the doctor shrugged and said it was his job.
"And then, as he walked out of the operating room, he turned and said, 'The next time you negotiate money away from a doctor, remember tonight. I was the one who was here,'" Howrigon recalls.
Howrigon spent the next three months on family leave assembling a business plan. He never returned to his job at Capital Blue Cross of Pennsylvania, where he held a vice president-level position negotiating fee contracts with doctors and hospitals.
That was five years ago. Now Howrigon, 44, is president of Fulcrum Strategies in Raleigh and works with doctors to win higher fees from insurance companies.
He's watching the congressional debate over health-care bills with trepidation. He worries the current health-care overhaul proposals will hurt doctors even more than he did in his past life.
"I don't see a single bill that solves the cost problem," Howrigon says. "And the consequences of some bills will solve the problem, but on the backs of physicians."
Howrigon, who has a master's degree in economics, says adding a public option as some congressional leaders have suggested would be especially problematic for physicians.
A public option, in which the government would basically offer an insurance plan to compete with private insurers, would likely reimburse doctors at the same rate as Medicaid and Medicare. In many cases, both government policies pay rates well below a doctor's cost of doing business.
"Medicare physicians do it because they feel a social obligation," Howrigon says. "As a business person, it doesn't make any sense."
Howrigon says private insurers would quickly cut their physician reimbursement rates to compete with the government plan, creating a huge hit on a doctor's salary. He said an average family physician could go from earning $150,000 a year to $90,000.
"It's hard for someone living paycheck to paycheck to feel sorry for someone making $150,000 a year," Howrigon said, "but it's only one piece of the story."
The other piece, he says, is that those doctors spend at least eight years in college, racking up six-figure medical school bills that must be repaid. Often the best and brightest of students in colleges, many would-be doctors would instead pursue other careers if the pay does not match the long hours and stressful work ahead, Howrigon says.
"The economist in me asks, how many physicians will retire, and how many will do something else?" he says. "If you add 30 to 40 million people to the rolls of the insured, and you're seeing an exodus of physicians, you create an access problem."
Despite concerns about how doctors will be affected, Howrigon says he's glad to see other elements of the health-care reform proposals moving forward. He says it's past due for insurance companies to cover people who have pre-existing health conditions.
"What makes good sense for profit doesn't make good sense for patients," Howrigon says. "Five percent of people covered by insurance companies account for more than half of all medical expenses. If you're a for-profit insurance company, and you can figure out how not to cover those 5 percent, you're going to make a lot of money. But those 5 percent need health coverage the most."
Howrigon says insurance companies aren't actually opposed to covering pre-existing conditions, since everyone would be forced to take a portion of the most expensive patients.
Whatever results from the current debate, Howrigon says he hopes the end result is an improved system.
"My concern is that the cure may be worse than the disease," he says.
