Participants

• Dr. Brian Barkemeyer ('79), neonatologist, head of the Division of Neonatology at LSU School of Medicine
• Dr. Kraig de Lanzac ('86), anesthesiologist, Slidell Memorial Hospital, president of the Louisiana Society of Anesthesiologists
• Wayne Francingues, Sr., broker at Francingues Financial Group, 43 years of experience in the insurance business specializing in employee benefits
• E. J. Giusti ('01), insurance broker with focus on voluntary benefits, disability, and life
• Dr. Albert Sam ('85), vascular surgeon, practiced ten years with a six-person group in Baton Rouge, now a professor at Tulane University School of Medicine
• Dr. Leni Sumich II ('90), ophthalmologist in a four-person group practice in Metairie, specializing in cataract and refractive surgery.

• Brian: We've led the world in the development of new technology and techniques. The ability to offer those strengths to the population is the weakness.
• Leni: We have the best-trained medical personnel anywhere in the world. But the weakness is that costs are skyrocketing. We have to practice defensive medicine because of problems with lawsuits, but that's part of doing business as a physician.
  
• Kraig: Our medical and nursing education is the best in the world. We have amazing technology to sustain life. ... You want to find out how much a procedure will cost, but it's difficult to calculate that in our bizarre system of medical care. Value-based purchasing in the Affordable Care Act may make some changes in that.
• Wayne: New knees, new hearts, all the things that have happened over the last 30 years - all that costs money. There's got to be a way to put all that together to provide the right type of services to help people live longer.
  
• E. J.: We live in one of the most willing countries in the world. We'll help anybody who's sick or hurt even if the hospital or doctor loses money. This hurts the people who pay for their health insurance because it increases their premiums to pay twice the number of claims.
  
• Albert: No other country has the uniformity of quality when it comes to medical care in our country. You may see a great disparity regionally in the care you're given in other countries. But a good doctor in New York City will be comparable to a good doctor in Topeka KS and a good doctor in New Orleans. But our weakness is that our population has by far the least access to good medical services.
  

What are good and bad features of the Affordable Care Act?

• Leni: In theory, what they're trying to accomplish is noble from an ethical standpoint. I don't think in this country that anybody should not be able to get health care. I don't claim to know how we'll pay for it. ... I don't know logistically if they're going to make that work. ... Part of the problem is the way the bill was passed ... They voted on a bill to drastically change the way that a huge portion of our gross domestic product is spent without reading any of details.
• Kraig – It started as Patient Protection and Affordable Care Act. But they cut the patient protection part out of it. As a consumer, I like the portability to carry my insurance over regardless of where I'm at. But the web site was the first step in multiple failures. We'll get down the road and find a lot of things were not well thought out. Government doesn't run businesses very well. This is all leading to a single payer system. That's a problem for physicians and patients as well as insurance companies. You'll have payment advisory boards, groups of individuals who decide what the payment to physicians will be. But no physicians in that field are on the committee.
• Wayne – I believe the premise of insuring every American is a bold one, and I believe everyone would agree with that premise. The problem is that was never the intent from day one. The intent was to take over 16% of the GDP. They said 30,000,000 people are uninsured. If you break that down, 10,000,000 people in round numbers couldn't afford insurance. Another 10,000,000 were sick and couldn't get it. And another 10,000,000 couldn't care less. They're young, bold, and bullet-proof and don't see the need for health insurance. We passed a law in the late '80s or '90s where hospitals had to see everyone who came in the door. That turned hospitals into doctors' offices for the everyday sneezes and whizzes. It clogs the system. On other hand, hospitals are not getting reimbursed because the people are uninsured. Now the law says everybody has to have insurance. If that's the case, the law that hospitals have to see everybody should be changed so that it has to be an absolute emergency before the hospital is forced to treat you. For people who didn't have insurance before, paying a $95 penalty is not going to drive them into buying a policy. ... More people will have no insurance, and people who switched because of health care reform will be paying more and getting less. So all the people who are healthy are paying for older and sicker people to balance off their premiums. ... It just can't work. There's not enough money in the world to do what this plan hoped to do.
  
• Kraig: Insurance companies can't pick and choose anymore. Companies will deal with that as shared risk. As a doctor, I get to share in that expense for a patient who wasn't as healthy or as cheap to care for. The company will hold back some revenues from me. The system pits insurance companies and physicians against each other.
  
• Wayne: Louisiana and every state I know of did things that needed to be done for people who were poor or sick and couldn't get insurance. Anybody that lost their insurance could go to the state of Louisiana with no questions asked and get insured. It was very expensive because of the high risk pool. The Federal Government could have come in and said we will subsidize that plan for every state. They could have done it for less than the 2-3 trillion dollars AHC will cost the next ten years. We also had LaCHIP for uninsured children from low income families. Everybody that can't afford it can get it. Mom and dad just have to sign you up.
  
• Brian: There are holes, people who are uninsured. A lot of times, it's by choice. They make no effort to take advantage of opportunities that are there. Or they make bad choices such as drug abuse that puts them at much higher risk. So instead of seeking care on a timely basis, you're well past the time when you could have prevented a more serrious illness. I see it over and over again in neonatal care. Any mom who is pregnant can get funded if they're not in private insurance. The government realizes that if we can get them prenatal care, there'll be a better outcome because we're being proactive. But not all of them take advantage - by choice, distance, lack of transportation, ignorance, lifestyle. Moms without appropriate care delivering high-risk infants that I make a living off of cost society and the state.
• Albert: I'm a pragmatist. It's the law of the land. It's here to stay. To argue about whether health care is a right or a privilege is a waste of time. That's already been decided. If somebodfy gets shot tonight without any way of paying, we're going to take care of them. Because we have to and because we have a moral responsibility as well. Health care in the USA is a right. The issue is how we're going to fund it. That's what the ACA tries to do. The best way is to get everybody in the pool, preexisting conditions or not. Is it the perfect solution? Absolutely not. But was Medicare? No. That's why you have Medicare Part A, Part B, Part C, and Part D because it was modified over time. Part D just came out in the Bush era, and its rollout was horrible too. But at no point did everyone want to go back. Let's talk about how to make it better. The #1 advantage for me is that children can stay on your health plan until age 26. My stepson just took a job with a startup. My 11 year old spent five months at St. Jude's. Time was when he would never be able to get insurance because of a preexisting condition. People who traditionally did not see a doctor will now be able to go. In Louisiana, 3% of the people use 42% of the Medicaid dollars. If we can get these 3% to see the doctor more often, we can reduce the 42% figure. Another feature of ACA is the minimum standards for insurance plans. The reason people are getting letters from their insurer is because their plans don't meet the minimal standards of the ACA.
• Kraig: The big benefit is that insurance companies are involved in the health of the patients. If I were the primary care doctor, let me get paid over the lifetime of the my patient on how well I take care of my patient. ... The emerging market is medical records, tying in doctors' offices to hospitals. Creating a single claim system regardless of the payer with a single claim form.
• Leni: We have ten people full time who handle our claims. People's Health is this way, Medicaid that way. This procedure must be preapproved for this company but not that one.

What advice would you give to patients, clients, small businesses, schools, etc.?

• Wayne: If a business has fewer than 50 employees, you can't be fined for not offering insurance. But if you have more than 50, you must offer insurance to any full-time employee defined at 30 hours per week. That provision has been delayed one year. Every employer must closely track the hours of the workers, adding to the accounting cost. If an employee is working 35-40 hours per work, but the employer cannot afford to put them on a health plan, he knocks them down to 29 hours.
• Kraig: Health care becomes part of finding a job. Know what's in your potential employer's health care plan. Do the research. Find out who does a good job. Know the employer's insurance plan, what's covered and what's not. Consumers have been empowered by this act.
• Leni: Health care may become like what you had with retirement plans - people funding their own retirement more.
• Wayne: Medicare Advantage Plans will end in two years, and the $5 billion goes into Obamacare. It will be eaten up without producing the results you want.