Steve Schilling, CEO of Clinica Sierra Vista

Steve Schilling doesn’t have much patience with doctors whose main request for health reform is more money from the government.

“One hundred percent of Medicare is an adequate reimbursement to sustain a business,” he said. If Medicare only covers a third of your full costs, he said, then the doctor is charging too much.

Medi-Cal pays a bit less, he said. But as CEO of Clinica Sierra Vista, which operates 15 clinics and mobile services in Kern County, plus some in Fresno and Inyo counties, Schilling says the worst payers he has to deal with are private companies, not government programs.

He blames that on the companies’ desire to pay bonuses to executives and dividends to shareholders. That money could instead be spent on care for their customers, he said.

In order to make profits, health insurance companies follow a formula, he said. “You have strict utilization controls and you beat down your provider community with very low reimbursement rates.”

But doctors can’t fight back, he said, because not accepting the low pay would mean losing their patients.

Still, Schilling said, doctors are doing well.

“None of these providers are leaving their business. They’re all driving pretty nice cars. I haven’t heard of a single one of them, in my 36 years of providing care, going into personal bankruptcies.”

Different insurance companies pay different rates. The insurance paid by companies for their low-income workers is often poor and doesn’t cover much, he said.

Schilling says that if “health reform gridlock” remains in Congress, he still expects to see some incremental reforms — extending Medicare and Medicaid to more of the uninsured, addressing portability and preexisting conditions, and dealing with drug company profits.

The government also has to deal with the shortfall of primary care doctors, he said, or any reform will be for naught.

“It doesn’t matter if there’s a credit card in your back pocket if there’s no place to shop,” he said. “We’re training far too many dermatologists and far too few primary care providers.”