Dr. Neil Christen toils in the same town, tending a crowded emergency room full of patients, some of whom need his care and others who don't but can't get help anywhere else.
Tim Harlin struggles to keep the doors of a rural Roanoke hospital open, worried that sick people who can't pay will bankrupt the community's primary life line.
Dr. Walden Retan has been making house calls to Birmingham's elderly for decades and takes comfort in knowing that all of his patients have access to necessary care.
Four health professionals acknowledge four different problems with America's health care system, reform of which is Topic A this week as President Barack Obama addresses Congress on Wednesday.
Each professional proposes a different solution.
Physicians, according to a Harris Poll in 2006, top the list of most trusted professions in the country, and both sides of the health care debate claim them as partners.
Conservative commentators urge followers to ask their doctors about the impending horrors of a "government takeover" of health care, while the Obama administration trumpets the American Medical Association's endorsement of its proposals.
Health care reform most dramatically concerns the 45.7 million Americans the 2007 annual census says are without health insurance. About 11 million of these people, according to census data, hail from households making at least $75,000. The voluntarily uninsured would be compelled to obtain insurance if pending legislation is passed.
The remaining 30 million Americans, according to the Kaiser Family Foundation, cannot afford health insurance but do not qualify for Medicaid. Under the congressional bills, these members of the working poor would enter a health insurance exchange, a menu of insurance options where they could shop for the best deal. Government subsidies would be available for private insurance. The controversial public option, which would be a government program akin to Medicare, would always be present in the exchange.
All Americans, including the uninsured and underinsured, would be allowed to use the insurance exchange.
The administration has stressed the public option's potential to drive down costs by competing with private insurance. Republican opponents contend that this will lead to a government takeover of health insurance because private insurance companies can't compete with a government plan that does not need to pay taxes. Reform proponents fire back that entities like Yale University, Aquafina bottled water and FedEx have had no problem competing with public universities, utility systems or the Post Office.
Conservatives, including Congressman Mike Rogers, R-Saks, have reiterated that the bill's more-than-trillion-dollar price tag will drown future generations in debt.
Dr. Angela Martin, a pediatrician in Anniston, treats mostly low-income children from her office on Leighton Avenue.
Martin supports the public option because she says it promotes her professional passion: preventative medicine. She said it encourages routine trips to the doctor, a practice that saves lives and dollars down the road.
"Anniston leads the United States in both heart disease and Type 2 diabetes," she said. "We have to look at when these diseases start, and the answer is childhood."
Martin said she treats 400 children in her clinic who are at risk for heart disease, Type 2 diabetes and other problems related to obesity. She said if money was allocated toward preventative measures, such as hiring a nutritionist or an asthma specialist, both children and taxpayers would benefit.
Martin said health insurance often does not cover obesity-related treatments.
"The problem is that if you have insurance but it doesn't cover what ails you, then you're effectively uninsured," she said.
According to a study conducted by government scientists and a nonprofit research group called RTI International, Americans who are 30 pounds or more overweight cost the country an estimated $147 billion in weight-related medical bills in 2008. The study, which was released in July and promoted by former President Bill Clinton, also found that these health expenses have doubled in the last 10 years and that taxpayers cover about half of the $147 billion through Medicare and Medicaid.
Martin hopes the administration will do a better job of explaining what reform means for individuals and their families.
"We need to have one person take the lead on this project, someone who will be the spokesperson and explain what is ailing our society," she said.
Dr. Neil Christen, as an emergency room doctor in by far the largest hospital in the county, is on the frenetic front lines of the health industry.
Christen said that he is not compensated for the large number of uninsured patients he sees at Regional Medical Center in Anniston.
"Private doctors can't afford to do charity work, so they'll send (the uninsured patients) to the emergency department," he said. "We see people going to the emergency room for worthless things. If there's a lack of knowledge about what their condition is, they're going to end up in the emergency department."
Tim Harlin, the CEO of Randolph Medical Center, said the unfunded mandate to treat uninsured patients in the emergency room places a huge burden on his hospital in rural Randolph County.
"We have a huge bucket of un-reimbursed costs, and we have to find profits in other areas," he said. "It's very difficult. I would guess that every single administrator in the state would share a similar story about the mandate to care for these patients.
"We are very supportive of reform that covers the uninsured, but not at the expense of shortfalls in other areas, like reductions of Medicare and Medicaid," Harlin said.
The House health care bill would cut $219 billion in federal payments to hospitals and insurance companies over the next 10 years, according to the nonpartisan Congressional Budget Office. President Obama has said that broader insurance coverage would justify these cuts.
Christen said that while he would ideally like everyone to have basic health care, he does not trust the government to carry out the effort based on his experience with Medicare and Medicaid. He said that Medicare, a model for the public option, has failed to control costs.
"I think that if there's government in the insurance program, there's going to be lots of abuse and misuse," he said. "Look at the people they do cover right now. Every state's Medicaid budget is broke. The first thing they do is quit paying the doctors and tell us 'You'll eventually get some money, maybe.'"
Christen also said that most doctors feel that tort reform would be helpful at reducing costs.
The nonprofit Congressional Budget Office released a study in 2004 that found no "statistically significant difference in per capita health care spending between states with and without limits on malpractice torts." The CBO also reported that malpractice costs amount to less than 2 percent of overall health care spending.
Christen said private insurance companies will not be able to compete with a public option and that the result will be a total government takeover of health care. He said he worries about ethical dilemmas resulting from finite resources and infinite demand in a government system.
"When the government takes over, there's only so many dollars, and there's not going to be enough," he said. "There's going to have to be rationing, and there's got to be a panel to decide where we're going to spend the dollars. What scares me is that it may not even be doctors, it may be bureaucrats.
"Right now, everybody has coverage through the last minute of their life. Grandma and Grandpa can be covered and there's no rationing," he continued. There's no 'you're too old and decrepit.' Right now, nobody's being judged by their social worth or whether it's worth it to spend the money on them or not."
Medicare for all
Dr. Walden Retan, a "half-way retired" Birmingham geriatrician, is a member of Physicians for a National Health Program, a nationwide organization that advocates a Canadian-style health care system, one that pays independent doctors with taxpayer money.
Retan said private insurance companies regularly ration care to maximize their profits.
"If you and your physician decide that the best thing for you is a procedure that your insurance company doesn't approve, then you'll discover that health care is already vigorously rationed," he said.
Retan said that criticisms of the health care plan stem largely from a lack of understanding of the public option.
"I think there would be more enthusiasm about something as simple as expanding Medicare to everyone; everyone understands that," he said.
Many political analysts have said that a single-payer, "Medicare for all" system would have no chance of passing the House or Senate any time soon.
Retan argued that the problems associated with Medicare result from a lack of funding for the program. He contended that conservatives deride Medicare for its impending bankruptcy but do not vote for the funding necessary to keep it afloat.
In the mid-1990s, congressional Republicans led by Newt Gingrich sought a $270 billion cut to Medicare spending.
Calling Medicare "an extraordinarily popular program," Retan said cries of "socialism" miss the mark.
"There are components of Medicare that appeal to the left, which is that it is government-funded," he said. "But, it is delivered by independent physicians and clinics. That ain't socialism.
"If you go to the Veterans Administration and receive care from a VA doctor, that's socialized medicine," he added. "We save socialized medicine for the people we have the highest respect for, our veterans."