Modified Tue, Oct 13, 2009 10:40 AM
Wider access is key to mending health system
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close xCHAPEL HILL -- 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.
Ask Rebecca Chasnovitz why she wants to become a children's doctor and she will say that she enjoys working with kids.
Talk with her a little longer and the fourth-year UNC School of Medicine student will reveal an experience that helped edge her toward her choice: As a child, she spent months in the hospital after being diagnosed with a rare kidney disorder. In later years, she switched doctors as her family switched insurance companies, something she keeps in mind as she thinks of reforming the nation's health-care system.
"When you're constantly changing insurance companies," she said, "it's really hard to figure out what's covered and what's not."
Chasnovitz wishes health insurance were not tied to employers, but sounds resigned to the fact that it will be. "That's the system that we have," she said. But she would like to see a government-run option to compete with private insurers.
Chasnovitz, 25, grew up in Cary. Doctors diagnosed her kidney disorder when she was 6, and she spent three months in Rex Hospital. The lifelong condition causes recurring kidney stones.
She graduated from Enloe High School and UNC before starting medical school. "I'm just one of those students who just always wanted to be a doctor," she said, as medicine allows her to solve problems while helping people. She was inspired, too, by the relationship she had as a child with her kidney specialist.
Now, as a medical student, she's approaching health care from a different angle.
"It's a confusing topic," she said, "even for someone in medical school."
To educate students on possible reforms and to provide a venue for sharing ideas, the UNC medical school is hosting a series of forums. The first provided an overview of the reform process, said Dr. Warren Newton, the medical school's dean of education, and future forums could delve into particular aspects of the proposals.
Changes in the nation's health-care policy could touch all parts of a doctor's job, Newton said, from the types of research conducted to the types of records that are kept and the ways doctors are reimbursed.
"We've tried to frame the discussion around what happens to patients as opposed to what happens to doctors," Newton said. "Ultimately, I think that's what the decision needs to be, not what makes doctors happy, but how will we improve the health of patients?"
Bring in the feds
Chasnovitz has ideas.
In addition to an optional government-run insurance program, she hopes the government spends more money on basic, clinical research. She thinks the implementation of electronic medical records, with some guidelines and oversight from the federal government, could improve efficiency among care providers.
The bottom line, though, is that she hopes more people will have access to affordable coverage.
"I'm hoping that my patients will have better coverage," she said, "and that helps my job."
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Universial coverage?
The issue: Fewer Americans have private insurance, while more are covered by government programs or are doing without insurance.
Key statistic: The percentage of Americans covered by private health insurance has declined from about 79 percent in 1980 to less than 67 percent last year, according to federal statistics.
The ideas: President Barack Obama's plan aims to provide universal coverage through a series of measures aimed at people not covered by private insurance or under government plans such as Medicare and Medicaid. Under his plan, most businesses would be required either to offer insurance or to help workers buy individual plans. The government would create exchanges where small businesses and consumers could comparison-shop among private plans and perhaps a not-for-profit government-run plan. Republicans don't talk about universal coverage and say they oppose government-run health care. They say far more people can be insured through changes to the private market, such as allowing individuals and small businesses to join together to get health insurance at lower prices, just as large businesses and labor unions do, and allowing them to buy insurance across state lines.
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