To spur you to respond to the state's healthcare reform proposal, I am sharing excerpts of the letter I sent Gov. Arnold Schwarzenegger in January. I encourage you to write to him as well.

Your health reform plan is misguided. Physicians are not the deep pockets you should be enlisting to pay for your proposed state insurance program.

First, 95 percent of physicians do not have a concentration of Medicare/Medi-Cal patients in their practices. It has not been financially viable to treat these populations in the past, and it doesn't appear it will be possible in the near future. Thus, if we do not have largely government-insured populations, the payment increases you propose for serving those groups will not be coming to a majority of doctors.

At the same time, you propose a levy on physicians to basically take back the pay increase you offer for seeing Medicare/Medi-Cal patients. Since this reimbursement increase was supposed to keep physicians from losing money each time we see a Medicare/Medi-Cal patient, I fail to follow your reasoning.

I work with five other pediatricians. Our medical practice is made up of approximately 7 percent Medi-Cal/CalOptima patients. With your plan, I might see increased payment for services to see these patients. But I will pay the state 2 percent of my gross income. Considering that I am struggling to keep my overhead from going over 60 percent of my gross income, your proposal would ruin two years of efforts to reduce my overhead.

Second, most physicians run small businesses with multiple employees. In our office, we provide 18 employees with salaries and health insurance. However, the premiums we can afford do not cover employees' spouses and children, and most employees cannot afford to spend the additional amount it would require to include their families. So they enroll their families in the state Medi-Cal/CalOptima insurance plan. We don't need to pay the state a surcharge for that insurance because we are already doing so.

Not only are we supposed to provide insurance for our own employees, but we are supposed to contribute to insuring the rest of the population. May I ask what has singled physicians out for your attention? Under your plan, we are not only to provide medical care using our extensive training, but we are to pay for people to get our medical care. How does that make sense?

No doubt, we need a broad reform plan. Insurance companies should stop cherry picking because it harms patients. Medical care for the uninsured should not take place in dire circumstances in the most expensive medical care setting, the emergency room. And our 750,000 uninsured children should have basic medical care.

There is a way to accomplish our ideals. Perhaps you have seen the California Medical Association's proposals for a single-payer health system (Resolution 215-06) and universal healthcare coverage (Resolution 214-06)? Doctors stand ready to discuss positive change. We are not ready, however, to pay more than our fair share for improvements.

Sincerely,
Dawn Bruner, MD