(Editor's note: This is the third in a series of stories taking a local look at national health-care issues.) Changes should focus on prevention, increase insurance coverage, simplify rules Any good mechanic knows the key to keeping a car running well, and running longer, is to maintain it diligently.Regular oil changes, transmission and cooling system flushes, brake-pad replacement and other routine procedures can make all the difference between a car that performs well for many years and one that ends up in the junkyard before its time.But, when it comes to healthcare for people, we often wait until something is wrong, then look for ways to fix it. That is one of many problems afflicting the health-care system in the United States, said Rod Barton, Powell Valley Healthcare director. “There is currently a focus on our health-care problems, but not on keeping people well in the first place,” he said. “The system pays more for procedures and tests, surgeries and MRIs, than it does for a doctor to sit with a patient.”“The entire (health-care) system is fraught with problems,” Barton said, and that is why trying to come up with solutions for those problems is so difficult.“There are very smart people who realize this is a complicated system with lots of problems, and they're trying to fix lots of problems at the same time. But that has complicated it beyond belief."

For instance, “doctors are given lots of latitude to determine what the best treatment is” for any given condition, Barton said. “There is a huge variation from Florida to New York to California.”

That variation in treatment produces varied costs, as well as varied results.

And that, he said, “drives a federal bureaucrats crazy.”

To address that, part of President Barack Obama's health-care proposal is to look at comparative effectiveness. A federal agency would determine what the best treatment is for illnesses and injuries, and medical practitioners would be given incentives to provide the treatments determined to be best.

“It takes away some of the variation, but also some of the flexibility on the local level,” Barton said.

But that very flexibility often is necessary for patients' welfare, he said.

“There's always those few people where the standard treatment doesn't work,” Barton said. “Why is it that penicillin is a miracle drug for 90 percent of the people, but kills the other 10 percent who are allergic to it? We can't say we should always use penicillin. We have to have flexibility. Not every person, not every body, reacts the same way to the same treatment ... That's the dilemma in health care.”

One of the biggest headaches, for doctors, patients and hospitals alike, is red tape — trying to make sure all the rules and regulations are met for different insurance companies, as well as Medicaid and Medicare.

“I'm no fan of insurance companies,” Barton said, “partly because there are many of them, and they all have their own sets of rules... Some say call 24 hours ahead, some 36 hours, and if you miss it, they won't pay us. That's what drives us crazy.

“It would be easier to have a single set of rules, and have a single payer.”

That is one of the proposals being thrown about in federal health-care-fix discussions.

“But,” Barton added, “having said that, I do worry about that if the single payer is the government.

“I've heard the debate about another public plan to go along with Medicare and Medicaid, and whether it would be better to expand private insurance.

“The dilemma is, private insurance is in business, and they have to make a profit to stay in business. They have to take in more than they spend, so rules limit who they will insure.

“Is one option to force insurance companies to insure everyone who comes to them? That would make insurance go up for all of us.

“On the other hand, to have a public program, it would have to be funded by taxes.”

Barton said he's heard people say they don't want socialized medicine.

But, “there's already a lot of it,” he said. “What do you call Medicare? And in may ways, it's a very successful program.

“Most people who have Medicare coverage like having Medicare. It does a good job for them ... The fear that they once had, what would they do about health-care costs in their old age, is gone.”

Barton said he believes Medicare's payment rates are too low. But, from a provider's perspective, “Medicare, in comparison, is a bureaucracy that is easier to get along with than the insurance companies.”

Barton said he's also heard concerns about the federal government rationing health care.

“We already have rationed care in this country,” he said. “We just do it on whether you have money, or you don't. People who do not have insurance do not go for care until they have a larger problem.”

In addition, insurance companies, Medicare and Medicaid already limit what they will pay for, based on what care is considered necessary for a patient's condition, he said.

“Most other systems out there come with restrictions,” he said.

There are no easy answers, and medical providers are as divided as the public about possible solutions, he said.

“Nurses and doctors recognize that something has to change, but there is fear of the government taking over and creating another bureaucracy.

“On the other hand, there is a deep dislike and distrust for insurance companies. From a provider perspective, they are seen as taking money in, but they don't provide care.”

One of biggest problems facing hospitals today remains the fact that so many people are uninsured, he said.

“We've reached a point where we're writing off about 30 percent of the bills we send out — nearly one in three,” he said. “A lot of that is due to people who don't have insurance.

“Part of Sen. (Max) Baucus' (D-Mont.) plan calls for decreases in hospital payments. I'm OK with that, with the assumption that more people will have insurance ... The hope is, if we increase the number of people with insurance ... I could decrease my charges.”

Despite the rancor over health-care issues, both at congressional and public levels, Barton said he is optimistic that something will come out of the debate that will improve health care in the United States. He hopes that will include a larger focus on preventative care, and that the health-care system will be simplified.

But he cautioned that any changes to the system now won't make it perfect tomorrow.

“We have to be OK with that,” he said. “Medicare is certainly a better program today than it was in 1965 when it was first enacted.”

He said he hopes lawmakers and the public can work together to come up with positive changes.

“We need to take enough time to be thorough,” he said, “but if we delay it too much, there will be too many things that will stop it.”