Obamacare

David Scheiner, an internist based in the Chicago neighborhood of Hyde Park, has a diverse practice of lower-income adults from the nearby housing projects mixed with famous patients like U.S. Sen. Carol Mosely Braun, the late writer Studs Terkel and, most notably, President Barack Obama.

Scheiner, 71, was Obama's doctor from 1987 until he entered the White House; he vouched for the then-candidate's "excellent health" in a letter last year. He's still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. "I'm not sure he really understands what we face in primary care," Scheiner says.

Scheiner takes a few other shots too. Looking at Obama's team of health advisors, Scheiner doesn't see anyone who's actually in the trenches. "I have a suspicion they pick people from the top echelon of medicine, people who write about it but haven't been struggling in it," he says.

Scheiner is critical of Obama's pick for Health and Human Services secretary--Kansas Gov. Kathleen Sebelius, who used to work as the chief lobbyist for her state's trial lawyers association.

"He doesn't see all the pain, it's so tragic out here," he says. "Obama's wonderful, but on this one I'm not sure if he's getting the right input."

What should the president be focused on? Scheiner thinks that a good health reform would be "Medicare for all," a single-payer system where the government would cover everyone and pay for it by cutting out waste in the system. "A neurosurgeon gets paid $20,000 for cutting into the neck of my patient. Have him get paid $1 million a year instead of $2 million or $3 million. He won't starve," Scheiner says.

Scheiner thinks that Obama's "public plan" reform doesn't go far enough. He supports the idea of that option for people who don't like or can't afford their HMO. But he worries that it will be watered down or not happen at all. "It's nonsense that the private insurance companies need to be protected," he says. "Why? Because they've done such a good job?"

He thinks that Americans have been scared into believing that they will lose the coverage they already have if a public plan is created. And he worries that nobody cares about the 50 million uninsured. "I have people who have lost their jobs and come to me and I give them drug samples," he says.

Scheiner says he thinks that Obama probably sees the virtues of a single-payer system but has decided it would be politically impossible to create one.

Reid Cherlin, an assistant White House press secretary who covers health issues, wrote in an e-mailed statement, "The President has been clear that while a single-payer system may work in some countries, it makes the most sense for us to build on what works in the system we have and to fix what's broken.

"He would certainly agree that there's too much waste in the system--where families, businesses and governments pay too much for too little," he added, "and that's why he's committed not just to expanding coverage but to reforming the health system to provide high-quality care at a lower cost to more Americans."

Scheiner says he never thought it was appropriate to talk about health policy with Obama, especially once he became a U.S. Senator. The one exception was medical malpractice reform. "I once briefly talked to him about malpractice, and he took the lawyers' position," he says.

Obama reiterated his opposition to caps on medical malpractice-related damages when he addressed an audience of doctors earlier this week at the American Medical Association's annual meeting. (See "Will Doctors Buy Obamacare?")

Scheiner, like most others in his profession, thinks that it should be harder to sue doctors and that awards should be capped. He says that he and other doctors must order too many tests and imaging studies just to avoid being sued.

Scheiner graduated from Princeton and then started at Columbia University's College of Physicians and Surgeons 50 years ago. After training in internal medicine in Chicago he joined a practice in Hyde Park. His partner was Quentin Young, a doctor known for supporting universal coverage and for briefly being the personal physician of Martin Luther King Jr.

Before selling his practice, he watched his income decline over the years to what he calculated to be $22 an hour ($2,100 every two weeks after withholding for taxes, health insurance and malpractice insurance.)

Scheiner thinks that any health reform should involve paying primary-care doctors better so they don't have to rush through appointments to make ends meet. He says that the medical students he encounters are no longer even taught how to do a patient history and physical exam. Patients get imaging studies and lab work instead of actual work-ups. "It's like in Star Trek where Bones had the thing he would wave up and down. They don't even talk to patients," he says.