Few people in Northeast Mississippi or Washington, D.C., would debate that health care costs aren't too high and enough Americans have health insurance.

But exactly how to get there without breaking the national piggy bank is still very much under discussion. Congress will keep debating proposed reforms this fall.

The Northeast Mississippi Daily Journal asked four physicians from around the region for their take on the health care debate and their prescriptions for reform.

"I don't think there's any physician or health care provider that will tell you there's no need for reform," said Tupelo gastroentrologist Dr. Barney Guyton, who also serves as the chairman of the Antone Tannehill Good Samaritan Free Clinic. "We need it to be more affordable and accessible to more people."

New Albany family physician Dr. Jason Dees, who serves on a national committee for the American Academy of Family Physicians, said he sees the need to reform the way health care is paid for every day in his clinic.

"I have patients who are cutting pills or skipping days," Dees said. "The health care system is sick, and more importantly for me, it's not working for my patients."

Ripley family physician Dr. Dwalia South, a past president of the Mississippi Medical Association, said she's worried about the massive cost of proposed reforms, but encouraged by the Obama administration's willingness to listen to the American Medical Association.

"I know that health care reform has been studied for years now, but Washington needs to have physicians and patients in the loop while this massive change occurs," South said. "They need to do this thing cautiously and get it right."

Tupelo family physician Dr. Ed Hill, who pushed health care reform with the administration of President George W. Bush when he was American Medical Association president, said he thinks the momentum for President Barack Obama's health care reform has been tempered by the delay in getting full House or Senate votes on legislation, but will continue.

"We're at the beginning of the whole process," Hill said. "It's a long way from the White House."

Encouraging signs

Northeast Mississippi physicians are hearing some encouraging signs from Washington, notably getting rid of exemptions for pre-existing conditions and working to make health care insurance truly portable between jobs.

The doctors said they support the idea that's been floated of a health care exchange, modeled on the federal employees health insurance, which offers a broad range of plans and costs, and people pick what works best for them and their family.

"The idea is that the government would set the plans and the insurance would offer them," Hill said. "It would allow insurance companies to compete on a level playing field."

However, a clear picture of what is actually being proposed hasn't emerged, and that worries Guyton.

"We've got to have a better idea of what we're getting so we know if we're opposed to it or not," he said.

Overblown rhetoric

Hill takes issue with the rhetoric coming from both sides of the health care debate. Talk about the worst health care system and the poorest outcomes for Americans is inaccurate, he said.

"We have the best health care available in the world," Hill said. "What they ought to say is that they don't feel U.S. citizens are getting value for the cost."

Scare tactics from the other side aimed at derailing any health care reform by painting bleak pictures of government-run systems in Canada and England also are hyperbole.

"Kids in Canada get chemotherapy," Hill said. "The majority of people in Canada are not as unhappy as we think they are."

None of the Northeast Mississippi physicians favors the idea of a single-payor system.

"I don't want a Canadian or English health care system," because there is rationing and delayed care, Guyton said. "I don't want to go backwards ... we need to use what we have."

Creating a public plan that operates like Medicare doesn't sound good to physicians, either, Dees said.

"I am concerned a public plan tied to Medicare rates," Dees said. "It's unacceptable for physicians. The current system doesn't value primary care."

Important elements

Health care reform needs to support a strong primary health care system, the doctors say.

"Every patient needs to have a medical home, a personal primary care doctor who is the quarterback of that individual's health care," South said.

Both Hill and Dees cited research done by Dr. Barbara Starfield from Johns Hopkins University. She looked at developed and non-developed countries across the world. Where people had a strong primary care base, costs were lower and outcomes were better.

That means there needs to be lots more primary care providers such as pediatricians, family physicians, internal medicine doctors and others.

The doctors are also supportive of some form of mandatory health insurance, just as drivers are supposed to carry liability insurance.

"Everybody must have some basic health coverage, and they need to be fiscally and physically personally involved in their own health care," South said.

Finding resources

The real, long savings to health care comes through preventive care and education.

Poor lifestyle choices like smoking, poor diet and lack of exercise make up a huge portion of health care costs.

Preventable health behaviors - alcohol and substance abuse, not using seat belts, risky sexual behaviors as well as poor diet and exercise - cost the United States $1.3 trillion a year in health care costs.

"If we reduce those 10 to 20 percent in 10 years, there is more than enough money to do those things," Hill said.

Individual responsibility is a key component of improving America's health, Guyton said.

"It's very important thing to say," he said. "But it's a very tough thing to accomplish ... the answer is through the education process."

South said she would like to see county health departments better used to combat chronic health issues.

"They used to be a place where chronic illnesses could be monitored and treated, and where life-saving medicine was provided to indigent patients," South said. "Counseling was provided for hypertension, diabetes, and obesity and other critical problems in our communities at little to no cost."

Finding the right solution for American health care is a tall order, but not an impossible one.

"When we get through this, we'll have the best health care delivery system," Hill said. "But it will be painful getting there."

Contact Michaela Gibson Morris at (662) 678-1599 or michaela.morris@djournal.com.