Sept. 14--Dr. Henry Poore founded the Poore Clinic in Flagstaff last fall to treat the so-called "working poor" -- those employed only part-time or working at low-income jobs at companies that do not provide insurance.

He also wanted to serve people like the homeless -- people with little to no income who, for various reasons, cannot obtain government-paid insurance for the poor.

What he has learned since is that he has no end of patients with really complicated problems best suited to a surgeon and sometimes expensive tests -- like a woman with breast cancer he saw this week in need of a mastectomy to save her life.

She's working part-time in a restaurant and has no insurance and little income.

If he were setting the agenda for national debate, Poore would ask politicians running for Congress and Senate, and the White House, about how they'd serve these folks.

"We have no place to send those that need surgery and have no insurance or money," he said.

He'd also ask about limiting lawsuits by patients against physicians in a bid to reduce malpractice insurance costs and the number of unneeded medical tests health care workers sometimes order to stay safe from lawsuits.

"Until we do something about tort reform and face the problem that all of us are practicing defensive medicine, we can't lower the cost of health care. We can't do it," Poore said.

Some of his patients have chronic, serious mental health problems and need treatment.

He has nowhere to send them either, he said, following state cuts to their programs.

"What are we going to do about the severely handicapped people with severe, chronic mental health problems?"

GETTING INSURANCE DIFFICULT

A little more than half of the people responding to a Kaiser Family Foundation poll in September 2011 said they had an existing health problem.

Of those, one-fifth said either they or someone in their family had difficulty buying insurance or had been refused.

These are the kinds of patients who would have an ability to buy insurance in 2014 if the Affordable Care Act remains in effect, though there is a demographic that could remain uninsured.

It's up to states to decide whether to expand Medicaid coverage for some living at or near the federal poverty level ($19,090 per year for a family of three, $11,170 for an individual).

Physician Michael Keberlein, a Flagstaff internist, estimates he has more than 500 patients, and he sees six to eight of them daily in his private practice.

He often sees the patients few other physicians want to spend lots of time with -- the ones with really complicated and numerous problems, some of whom are taking 15 or 25 medications.

Sometimes, he has to make educated guesses about what to do, when treatment for one problem conflicts with treatment for another.

And he signs death certificates.

If he were setting the agenda for debate on policy and health care, he'd ask why the insurance companies will be guaranteed future business if the Affordable Care Act stands, and why there isn't some expansion of a government-run system.

"What does the (candidate) think of expanding the Medicare system to all people?" he'd ask.

LIKE MAIL DELIVERY

He sees it like mail delivery: Give the public a number of options -- private insurance, public insurance or a blend.

"If the Postal Service can compete with Federal Express, UPS and DHS, why can't the insurance industry compete with the public option?"

Keberlein would ask political candidates whether the public has more of a stake in health care if everyone shares the risks and costs of being vaccinated, getting sick or trying to stay well.

Cyndy Cole can be reached at ccole@azdailysun.com or at 913-8607.

2012 CAMPAIGN AGENDA

Today: Health Care

Monday: Jobs/economy

Tuesday: Forests/federal lands

Wednesday: Schools

Thursday: Water

___

(c)2012 The Arizona Daily Sun (Flagstaff, Ariz.)

Visit The Arizona Daily Sun (Flagstaff, Ariz.) at www.azdailysun.com

Distributed by MCT Information Services