Three Marshall County doctors, two political party chairmen, state and federal lawmakers and some local leaders have praised and criticized the health care bill signed into law Tuesday by President Barack Obama.
With their own views on whether the historic reform of the health insurance system is a panacea or problematic, the local residents acknowledged it's such a big change that they couldn't know it all. Their insights were sought because of their work.
"It all boils down to more care with less money," Dr. Kenneth Phelps Jr. said. The good things include the prohibition against denying health insurance to people with pre-existing conditions and keeping children on their parents' insurance longer.
Dr. Benny McKnight said the old system was "not very good" because government forced hospitals - those that are paid by Medicare - to treat people free. That transfers the cost to people with insurance. Reform will help that. It ends entitlement and requires responsibility.
"But these," Dr. Tim Nash said, "are big payment issues for economists; more for them than medical issues... Politicians do not understand the forces that drive health care costs... If you give someone health insurance, they're going to use it."
As for what's wrong with the new law on health care coverage, Marshall County Republican Party Chair Shirley Lowe cited the "$3 trillion ... debt."
Asked about ending insurance companies' ability to deny coverage because a policy applicant has a medical condition that will require treatment, Lowe said, "We've needed some form of health care reform and I think that is an issue that should be covered."
The issue over pre-existing conditions proved to be problematic for Lowe's counterpart, Marshall County Democratic Party Chairman Chris Collins.
"I can see both sides of that," Collins said. "I do come from an insurance company family."
The son of the man leading Collins & Miller Insurance declined to comment further on that aspect of the new law, but he pointed to advantages such as "keeping your child on your health insurance to age 26. That's important because a lot stay at home while they're in college...
"But most importantly, is being able to give small businesses the leverage to compete with large companies when getting good insurance rates for their employees," Collins said.
"People need to look at the program and not take what everybody else is saying," he said. "I think there are benefits for most Americans."
"A lot of this," Nash said, "depends on the details which we don't know yet."
He said he doesn't believe it will help his practice because of Medicare. More than 60 percent of his patients' bills are paid that way. Problems will arise if payments don't keep up with inflation.
"When I left med school, I owed $33,000" 25 years ago, he said. "Now, it's about $100,000" for young doctors.
"Obama wants to cover many more, but there won't be enough primary care physicians... The latest survey shows only two percent of new doctors want to be primary care physicians...
"Others go into specialties," he said, citing various reasons.
One is money.
"Even if you don't pay the doctors more," Phelps said, "all the ancillary people have to be paid by the hour and so it's going to end up that the physicians are going to have to cut back and work for less and, unfortunately it doesn't appear - from my knowledge of the bill - that there's any differentiation between the primary physician and the specialists."
Reform comes "when the nursing shortage is at an all-time high," Phelps said. "So, where are the health professionals going to come from?"
McKnight offered some insight on physician finances.
"We always compare our health care system to Canada and Europe... They don't have malpractice" lawsuits," McKnight said. "Medicine in this country is the best there is, but there are too many unnecessary lawsuits. Doctors practice defensive medicine because somebody might say, 'You didn't find that ingrown toe nail.'"
Furthermore, he said, most doctors in Canada went to a government school for free. "We do have state-supported schools that are less expensive."
Tort reform (legislation that would change the rules on litigation) has been a political issue for decades and other big issues were raised by local leaders on health care reform.
Lowe is "concerned with the abortion issue and that my tax dollars will be paying for something that I do not believe in," she said.
Asked about a White House action to prevent that, the County GOP chair replied, "I am aware they said they might do something in that direction, but until I see it, I think they were promising things just to get the bill passed."
Lowe is executive director of the In His Image Pregnancy Center.
Abortion is an issue McKnight addressed with remarks about hospitals that must treat all who seek treatment.
"If a girl comes in and is bleeding," he said, "you have to treat her."
He doesn't abort babies because he's not an OB-GYN doctor and it's contrary to his beliefs. But if a pregnant mother with five children and no husband needs treatment to save her live instead of the child; "That's a hard decision."
The system isn't perfect, but "Working people need help," McKnight said.
Votes from Tennessee's Congressional delegation include:
* Sen. Bob Corker voting no, complaining Medicare savings are counted twice.
* Sen. Lamar Alexander voting no, in part, because "It will increase the national debt."
* Rep. Bart Gordon voting yes, because it will lower the budget deficit and health care costs.
* Rep. Lincoln Davis voting no, saying the overwhelming majority of his constituents oppose the plan.
Meanwhile, Lt. Gov. Ron Ramsey said the law is unconstitutional and he wants Attorney General Robert Cooper to challenge it in court with 11 other state Attorneys General.
And after Marshall County commissioners met Monday night, Commission Chairman Billy Spivey questioned the new law since, under one view, patients being rushed to the hospital from a traffic crash might sign up for health insurance coverage since they couldn't be denied for having a pre-existing condition.