Stephanie Phillippi brushes the hair of her husband, Doug, at their home in Carrboro on Saturday. Doug Philippi has been coping with Lou Gehrig's disease for 13 years with care from his wife and two nurses.
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DURHAM -- The country spent an estimated $2.4 trillion in 2008 on health care and is projected to spend $4.4 trillion a year by 2018, according to the national Department of Health and Human Services. Premiums have been increasing for years, and so the thinking goes: Why is it that such an expensive system still can't deliver? Why are there still 47 million people without insurance?
Physicians themselves differ on the solutions.
Some physicians believe there needs to be more government intervention, while others believe less government would be more effective.
Franc Barada Jr., a rheumatologist for more than three decades, is chairman of the board of directors for Project Access of Durham County. Barada said the public option could make it impossible for some physicians to maintain their private practices.
"If any public option is brought in, if they bring it in at Medicare rates, physicians are going to have trouble with that," he said. "If a primary physician saw only Medicare patients, they couldn't really function."
At Barada's practice, private insurers pay him 30-60 percent more than Medicare, he said, and if the office was run entirely on Medicare, it would have to let go of staff members and cut costs.
Howard Eisenson, president of the Durham-Orange County Medical Society and a diet and fitness physician at Duke, said he supports a public option himself, but noted that many physicians distrust the government.
"There is a feeling that the government will take this on in a way that will unfairly compete with the private industry, that there will be difficult bureaucracy to work with ... , that reimbursement would be so low that people wouldn't be able to stay in practice," he said. "Primary care reimbursement is already too low."
Primary care and preventive care have also been emphasized in reform, Eisenson said, and some specialty doctors may be wondering how reform might affect them in turn.
At the same time, reform is also a political issue for physicians, Eisenson said: "Some feel that there should be more personal responsibility, that the market should operate more freely."
And personal responsibility, a focus on preventive measures and reasonable delays in health care may be what Americans aren't ready to hear.
"Americans want what they want, and they want what they want tomorrow. But not getting what a patient wants immediately is not necessarily bad care," said Leslie Greenwald, a principal scientist at RTI International who has researched health care for both the George H.W. Bush and Bill Clinton administrations.
"The public has always wanted health reform," she said. "It's just that they don't like health insurance companies, but they don't like government either."
Ask people about health insurance, and you get a mixed bag.
Stephanie Phillippi and her husband, Doug, who live in Carrboro, have struggled to deal with the cost and coverage issues stemming from Doug's Lou Gehrig's disease diagnosis 13 years ago.
They've been on Medicaid since 2001.
Without insurance, their health care costs would be more than $350,000 a year, she said.
Fortunately, Doug Phillippi had taken out a long-term disability policy before he was diagnosed, and between payments from that policy and Medicaid, the family has learned to survive.
Stephanie Phillippi is in full support of a public option.
Summer Kinard said her family is happy with their insurance plan obtained through her husband's employer, Cisco Systems.
"We've been lucky to be healthy during the periods of our lives when we had no coverage. But now, the difference is amazing," she said.
But some residents with coverage are not happy with their situations. "I do not like my health care insurance, and it is supposedly a good one ..." said Thomas Brothers, a music professor at Duke.
