We’re asking people in the health care industry in Bakersfield to tell us what’s going on in their practices, and how they would reform health care to solve their problems. Here is the first in our series on “The Health Care Reform Debate At Home.”

Michelle Quiogue

Michelle Quiogue is a family doctor at Kaiser Permanente, and she loves her job. But she wants to see more doctors like herself.

“Every year there are less and less (medical) students choosing primary care. Every year, people are choosing specialties because they see where the money is,” she said. “We have great access to specialty services, but not good access to primary care.”

Working for Kaiser, a nonprofit, she gets paid a salary for doing her job, rather than being reimbursed a set amount for each office visit, consultation and procedure. And she doesn’t have to worry about bringing in enough money to pay the rent and staff.

“It frees me to make medical decisions based on evidence, rather than based in my own little silo.”

The common fee-for-service model that dominates health care today doesn’t work well for primary care, she said. Doctors have to see up to 40 patients a day to pay the bills, and they don’t get paid for spending extra time on what she calls “meaningful care.”

She is working for an insurance company, though, and there are cost controls.

“Because we work collaboratively and it’s a physician directed practice, we have utilization committees, which are physician-run,” she said. The committees keep an eye out for too many scans, or prescriptions of expensive drugs when cheaper ones in the company’s formulary would do.

But the real cost savings comes from preventive care, she said.

“We catch colon cancers early, so we don’t have as an insurance company to pay for cancer care.”

Quiogue supports the House bill, in part because she has seen so many of her patients losing insurance when they lose their jobs. She said she’d like to see a government option that disconnects the job from health insurance.

“It doesn’t make sense for employers to choose your doctor,” she said. “It’s such a challenge to find a doctor that you can trust, and for that relationship to be vulnerable to your job doesn’t make sense.”

And costs have to be brought under control, she added.

“No one can afford their premiums anymore. Businesses, doctors, families are going bankrupt because of health care costs.”

How would you reform the corner of health care where you work? Contribute to our Virtual Roundtable.