All-Star Panel: Doctors discuss ObamaCare changes, challenges

'Special Report' panel weighs in on Affordable Care Act


This is a rush transcript from "Special Report," March 21, 2014. This copy may not be in its final form and may be updated.

BAIER: You've seen the stats. Now let's talk to some doctors. It's time now for our all-doctors panel, Dr. Chris Lillis, internist and Virginia State director of Doctors for America, Dr. Leigh Vinocur, board-certified emergency physician and adjunct assistant professor at Louisiana State University Health, Shreveport, Dr. Marty Makary, cancer surgeon and professor of health policy at Johns Hopkins University, and Dr. Ben Carson, professor emeritus of neurosurgery at Johns Hopkins as well. Thank you all for being here.

I want to start this first panel and talk about what you're seeing out there, the problems now that we hear from patients and consumers. What are you seeing out there?

DR. BEN CARSON, JOHNS HOPKINS UNIVERSITY: Well, you know, I run into obviously, a lot of patients because I'm all over the country and a lot of physicians, and it seems like the biggest problem is that we have insinuated into the doctor-patient relationship a lot of things that don't need to be there. What do you need for good health care? You need a health care provider and you need a patient. Well, along comes the middleman to help facilitate the relationship, and now it has become the predominant entity with the patient and health care provider at its beck and call.

So when you do that you basically create a sort of a different world. And, you know, when we talk about solutions, I want to talk about ways to bring the relationship back to the patient and the doctor.

BAIER: What about challenges you're seeing, real-world challenges for doctors?

DR. MARTY MAKARY, JOHNS HOPKINS UNIVERSITY: Well, I did have one patient give me $20 as a tip and say, here, I know you're getting screwed by ObamaCare right now, but the truth is a lot of my life is the same. I'm not as concerned about what's in the Affordable Care Act as what's not in there, and the challenges that remain for the health care system. People are getting crushed out there with their premiums. The deductibles are $10,000 for the bronze plans and $5,000 for the silver plan, the most popular plan. The problem of medical price inflation is continuing. People are seeing it in their pockets. And unless we address that with some real reform coming up, I think we're going to be looking at a continuing crisis.

BAIER: Leigh, the expansion of Medicaid obviously, is a big part of this, and for doctors, it becomes a big issue.

DR. LEIGH VINOCUR, LSU HEALTH SHREVEPORT: Yeah, as an ER physician, we have always said having health insurance doesn't mean that you have health care. And before the expansion of Medicaid, now there's going to be 20 million more patients probably, only about a third of doctors were taking new Medicaid patients. And, you know, it's a myth that the ER was filled with uninsured patients. There was a CDC study and another [inaudible] study out in 2009 that said only about 15 percent to 17 percent of patients that were coming to the ER, they weren't coming because they didn't have insurance -- 40 percent were private insurance.

And we know from Massachusetts with universal health care that ER visits went up. And as an ER doctor, the American college of emergency physicians just did a big study of the state of emergency medicine, their report card. And they said right now we get a D-minus for access to care because we're stretched beyond limits. So now you're supplying people with insurance, so you're increasing the demand, but there's a big physician shortage that nobody is addressing. And that's going to be a problem.

BAIER: I guess the administration would say or supporters of this would say, well, for hospitals and doctors who were not getting paid before, this expansion allows them to get paid by this additional numbers. Is that a fair argument?

DR. CHRIS LILLIS, DRSFORAMERICA.ORG: I think it is. I think there is a certain degree of reductions in uncompensated care. But we're talking from the doctor's perspective at the moment. From the patient's perspective, I have been volunteering in free clinics for 10 years in Virginia, and these are folks that either had a preexisting condition, couldn't purchase their own insurance because they were cut out of the system, or they couldn't afford it. And the Affordable Care Act extends insurance to these folks with fairly substantial tax subsidies on a sliding scale based on your income.

BAIER: If you are somebody who is caught in the middle here and wondering whether you, you know, in a narrow network, how you can go to doctors, what do you say to them? Do you say hold on tight, we're going to try to figure this out?

CARSON: I would tell them to make sure they save as much money as they possibly can because the thing is in flux and it keeps changing. You don't know from month to month what the requirements are going to be or when another delay is going to happen.

But I would say there are people who are working on this, very credible people. And, you know, I've got a stack of things on my desk that high from proposals people are sending from all over the country, extremely bright people with a lot of experience, physicians, terrific ideals. And you know, one of the things that was lacking, unfortunately, with the Affordable Care Act is the time to actually sit down to discuss this with people who really have experience there.

You know, we're smart people, and if we can sit down, remove the politicians from this, from the fray, and bring in people who actually know how to solve problems, we could have gotten this done quite effectively. And, you know, we spent twice as month per capita as the next closest country, and yet look at the access problems we have. You know, we haven't even addressed the fact that we have insurance companies as a major pillar, and they make money by denying people care. These are things that need to be fixed.

BAIER: We're going to talk about possible solutions with our All-Star doctors panel after this. 

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