John Updike - COO, Mineral County Hospital
What do you foresee in the quality of American health care?
"For the people who don't have insurance, the quality of their care will go up."
"If we only have doctors we have now because of doctors leaving medical care and retiring and not as many doctors coming in, it will affect it some that way, but we are having more PA's and nurse practitioners being trained and they'll, I think, make up the difference. "
"There are some critical access hospitals that are 30 or 40 miles away from another. Some of them could close, but it's doubtful because resident of communities want to keep their hospitals open."
Will I be able to keep my doctor?
"We don't know for sure on that. It's probable you can but it's possible you will not be able to.
It depends on how many patients there are and whether the primary care physicians and the specialists can still see the same numbers of patients. The American Medical Association is pushing hard so that physicians can continue to see their patients they've seen over the years but we don't know for sure. "
If you could explain for the lay person... why would they have to lose their doctor?
"We presently have around 35 million uninsured people in this country. If that is the case... and the Affordable Care Act gives in insurance to another 25 million people, then we will have 25 more million people to take care of who have insurance… Some doctors could become too busy to see patients. Another aspect of the Affordable Care Act is the paperwork. Physicians are being asked to do more and more paperwork on each patient. It takes more time. Some doctors have opted out of Medicaid and some Medicare patients because the paperwork demands are so great. "
Will some doctors not take the federal insurance because it won't pay enough?
"If some physicians have very large practices where they have private insurance, they are going to concentrate on that first, and take very little of the new affordable care act patients, but I think there will be a day in the next 3 or 4 years when the great majority of patients will have insurance through the affordable care act of some kind and those doctors will take those patients because there won't be enough work otherwise.
"We have about 200,000 physicians from outside the country, who are educated outside, come in, do a residency in this country and fill up the needs, many of the physician needs throughout the country. We are losing a number of physicians who are retiring. We are not replacing those primary care physicians fast enough. So, we will have a shortage, which hopefully will be made up by mid-levels: the Pas, the nurse practitioners."
"… we will still have the same number of physicians, or enough physician assistants or nurse practitioners to take up the slack if we don't have enough replacement physicians taking care of the spots of those who are retiring. The retirements have come faster, though, than normal. Doctors seem to be retiring a little earlier in their careers. Rather than waiting until they are 64 or 65, they are retiring at 61, 62, saying I am getting out of this mess but our medical schools are doing alright educating new physicians and we hope more of those physicians will become primary care rather than specialists. "