The battle over health care reform: Do local doctors and clinics support President Obama's government insurance plan? 

To perhaps over-simplify the local reaction, most everyone agrees we need some form of healthcare reform, to provide a more stable, affordable system; however, some take issue with this particular proposal.

As we've been reporting, there are two central points of the current proposal: lowering the cost of health care, and finding a way to cover the 43 million uninsured Americans. Some 30,000 of those uninsured people live right here in Deschutes County, and it's estimated over half of our local employers don't offer insurance plans.

The Volunteers in Medicine Clinic in Bend specifically takes those patients, without getting any federal funding. There, the number of patients has shot up 23 percent in the last year, and new patient screenings are booked out for months.

"Wee certainly have the philosophy here at this clinic that everybody should have access to health care, and that's why we exist," VIM Executive Director Katherine Mastrangelo said Thursday.

She compares the issue to education: both public and private choices exist. People aren't forced into either option, but both are needed. 

"We see it as a right that we should educate the children in this country," she said. "Well, in the same perspective, I think we should be willing to provide access to medical care."

The challenge with health care is this: The fewer people who pay into the system, the more insurance costs for everyone else.

"We're in a death spiral right now," said Bend Memorial Clinic CEO Marvin J. Lein. "We need to get people back into the system, and I think the Obama plan is about, in part, getting folks insured again."

But would a government insurance option be effective? Lein says yes, but only if it will reimburse providers at the same or similar level as private insurance.

If it's lower, that could mean future cuts to doctors and nurses to meet the bottom line.

"It's difficult to sit here and say part of the solution is about money," Lein said. "But that, in fact, is what we're talking about: The cost of health care."

Locally, some of our largest employers are in medicine. In terms of the number of employees, St. Charles Medical Center leads the list at number one, BMC ranks at number 10, and Lifewise and Clear Choice Health Plans aren't far behind. Together, they employ nearly 4,000 people.

A Lifewise Health Plan spokesman says they support the idea of health care reform in order to create a more sustainable system, but have real concerns about this proposal.

"A government-run plan would place unsustainable financial pressure on doctors and hospitals, which would thus harm patient access," spokesman Eric Earling told me by phone.  "A government-run plan would also have unintended consequences, by driving up the cost of coverage for everyone else."

But others appear to support the idea.

"If we change how we think about it, and we see that this is maybe not the big scary thing we think it might be, I think people are going to be more comfortable with it," Mastrangelo said.

"Anything that gets quality health care, that makes quality health care available to patients and members of our community, has to be a good thing," Lein said.

"That's where you have to start, with that kind of commitment," he added. "How you do it, yes, the devil is sometimes in the details. But I think we as a community, we as a country, have to proceed down this path, or we will not have the kind of society we built over the last 65 years moving forward for our children. That's our obligation."

However, there are still a lot of questions about how this plan would work.  The experts I spoke with say that the details of this plan, how it would blend with Medicare and Medicaid, plus whether medical malpractice lawsuits will be limited, all still need to be addressed.