SPRINGFIELD — Beth Payton was at work when she felt her lungs start to fill up — the all-too-familiar sign of another severe asthma attack.

As her breathing became more labored, co-workers urged her to let them call an ambulance. She tearfully refused.

“They saw the situation from a medical-need point of view,” she said. “But they didn’t know that I was still paying for the last time I was in the hospital.”

By the time a co-worker got her to the hospital, she had stopped breathing.

“That was the first time I ever coded,” she said.

Payton, 41, has insurance — “good insurance” — but in the 20 years since she was first diagnosed with asthma, she has worked two jobs to try to keep up with the overwhelming number of hospital bills not covered by her insurance.

“Just think, if that’s how it is for me, someone with insurance, I can’t even imagine what it is like for someone with no insurance,” she said.

As lawmakers debate whether the government or the private sector can provide the better care for all Americans, Payton said she only hopes, in the end, care will trump finances.

Cost, however, appears to be the sticking point that has sent lawmakers home this week without a bill to vote on.

President Obama hoped lawmakers would finalize a bill before the August break. But expanding coverage to an estimated 45 million uninsured Americans carries an estimated cost between $900 billion and $1 trillion, and fiscally conservative lawmakers have balked on proposals to cover that cost with cuts in Medicare and tax increases on the wealthy.

The Ohio Department of Insurance estimates that 1.3 million Ohioans are without health insurance — 200,000 of them children.

The report does not break down by county the number of people in the state without insurance, but Dr. James Duffee, chief medical officer at the Rocking Horse Community Health Center, believes Clark County has a disproportionate number of uninsured or underinsured individuals.

The Rocking Horse this year was named a Federally Qualified Health Care Center because of the area’s high number of low-income and uninsured individuals and the shortage of medical professionals.

This week, the News-Sun sat down with five local medical professionals to find out what they believe is the main issue with health care — especially in Springfield.

Each had a different perspective on the issue but each agreed the system must be fixed.

“I believe it’s a matter of social justice,” Duffee said. “To preserve their human dignity, everyone should have basic health care provided to them by the community.

By Kelly Mori

SPRINGFIELD — Health care coverage for all Americans has been the main focus of the health care debate since it began this spring. But Clark County Health Commissioner Charles Patterson said insurance is only the tip of the iceberg when it comes to providing health care for all.

“Portions of Clark County are designated health professional shortage areas,” Patterson said. “That means if everybody had health insurance there aren’t enough doctors in Clark County to (provide the care).”

With fewer physicians going into primary care and many more getting ready to retire, “we’re within 10 years of losing an incredible batch of talented physicians in this community,” he said.

Primary care physicians are the hardest hit and are quickly becoming the least favored area to go into, said Dr. James Duffee, medical director at the Rocking Horse Community Health Center.

Doctor shortage looms

“Primary care doctors, pediatrics and family doctors, are the lowest paid of any specialty,” Duffee said. “We’re getting to a point where people are coming out of medical school with $150,000 in debt — so much debt they can’t afford to go into primary care.”

That all adds up to higher costs for everyone, Duffee said. “The (shortage) is why we have 80,000 to 90,000 emergency room visits every year,” he said.

Community Mercy Health Partners treats all those patients, regardless of their ability to pay — “That’s our mission,” said CEO Mark Wiener — but as the number of people without the financial means to pay for medical service increases, it puts a strain on delivering care.

“Our resources are finite,” he continued. “This is not unique to (Community Mercy). This is a nationwide issue.”

Lawmakers are tossing around several proposals to address that issue, such as requiring businesses to provide coverage for employees, establishing a public insurance plan that would compete with private insurers, and creating subsidies for low-income individuals to help them obtain coverage.

Wiener said he is not alone in his concern about what the final package will look like.

“I just hope it will make health care affordable and accessible to everyone,” he said.

Quantity vs. quality

The current system of reimbursing physicians for “quantity, not quality,” is another problem lawmakers need to address, said Dr. Richard Nedelman, a general surgeon at Ohio Valley Medical Center. Currently, doctors receive higher reimbursement for procedures, tests and the number of patients they see rather than for patient outcomes, he said.

Many of Springfield’s working poor have entry-level insurance that won’t pay for preventative care, such as well-child visits or screenings, Duffee said.

“It’s not managed care, it’s more like ‘no care,’ ” he said. “These are for-profit businesses that make money by denying care.”

One exception is Care Source, Duffee said. The Medicaid managed care company pays the Rocking Horse a bonus each quarter based on the type of preventative care the center provides, including documenting the number of well-child visits or the number of patients whose high blood pressure is being managed through preventative care.

The program requires extra paperwork, “but they pay us for performance,” Duffee said. “That gives us an incentive.”

Nedelman said it’s disheartening that one of the biggest causes for high health care costs — malpractice lawsuits — is not being addressed. “There’s such a fear of being sued” that doctors practice defensive care, ordering multiple tests for even relatively minor conditions because they don’t want to leave any cracks for a lawsuit. Those tests contribute to the high cost of health care, he said. “We’re talking about billions of dollars.”

Drug costs

Springfield pharmacist Eric Juergens sees the financial struggle that patients have after they leave the hospital or the doctor’s office. “The biggest need is for affordable medications. Right now we have senior citizens falling into the (doughnut hole of no coverage) with Medicare Part D. We’re tying to manage people’s medication, but there’s just no provision for that.”

Juergens would also like to see co-pays removed from Medicaid plans.

“Their (premiums) are covered, why not their co-pays as well?” he said.

Pharmacists start early in the year working with patients to help them stretch their Medicare coverage so they don’t fall into the doughnut hole before the end of the year. Juergens would like to see some drug companies share a little bit of the cost.

Pharmacists see about a 3 percent profit, “that’s about 20 percent for drug companies,” he said. “We’d like to quit taking it on the chin.”

Duffee is a proponent of a one-payer system, using the success of the Federally Qualified Health Care Center — Rocking Horse — which receives much of its funding through federal reimbursements, as an example.

However, Nedelman, who has worked under Scotland’s national health care system, finds national health care “an imperfect system as well.”

National health care, at least the Scotland model, limits access, he said.

“People say if you live in that country (with universal health care) you can get health care when you need it,” he said. “But the level of care that people can receive is much different than what they get here.”

The latest proposals from lawmakers include a mixed payer system with the government competing with private insurers. Proponents say it will keep private insurance costs in check, while opponents say it will remove patients’ right to choose and put private insurers out of business.

Asthma patient Beth Payton said she doesn’t have a preference of payer systems, as long as it doesn’t force sick individuals to experience what she did in April — putting off going to the hospital because she was afraid of more hospital bills. That decision almost cost her life. “We should be taking care of people. We’re not doing it. Something needs to change,” she said.