To Byron Holmes, a long-term substitute teacher at West Prep Academy, the health care bill approved by Congress doesn't mandate insurance coverage quickly enough.
"I'm overjoyed that it passed, but it makes me very uneasy to be without insurance for another few years," he said Monday. "Greed has stood in the way of something people need."
To Dr. Richard Chudacoff, who specializes in obstetrics and gynecology, the bill's passage is a definite step backward for physicians because it allows government to set more fee schedules.
"It's a sad day in America. ... We don't get paid right now what we're worth," he said. "Nobody's going to want to be a doctor anymore."
Only one thing is clear now that the major overhaul of the nation's health care system has passed: Everybody has a passionate opinion, particularly about how it hits the pocketbook, unless you're talking to the biggest player in Nevada's health care insurance industry.
At this time, United Healthcare won't say where it stands, offering this prepared statement: "Now is the time for the difficult work of translating new law into market-level execution ..."
But non-positions aren't easy to find in the wake of passage of a polarizing bill that the Congressional Budget Office estimates will cost $938 billion over 10 years while covering 32 million uninsured and prohibiting insurers from denying coverage to people with medical problems.
Dr. Ole Thienhaus, dean of the University of Nevada School of Medicine, isn't surprised at the controversy over the bill.
"It was the same way in 1965 when Medicare came in," he said. "You would have thought from some people that we had the Soviet Union moving in here."
Two years ago, the 62-year-old Holmes lost a job where he long had health insurance when his employer, a major corporation, downsized. Because he isn't a full-time teacher, he doesn't get the health care benefits afforded by the Clark County School District. He said buying affordable insurance on the open market on a substitute teacher's pay isn't feasible.
"I'd have to spend half my net pay on health insurance," he said. "That wouldn't give me much to spend on incidentals like food and rent."
Holmes said he is concerned that he might suffer some of the same health problems that beset many African-American men his age, namely heart and prostate disease, and then have to wait for an emergency to be treated at a hospital emergency room .
Chudacoff, who led a physicians' march on Washington in October to protest the proposed health care bill, has long said the profit motive that is central to the country's entrepreneurial spirit and greatness helps ensure that doctors give the highest quality care to patients. He said that doctors who go to school for many years deserve a solid opportunity for material gain and that many will now leave the profession.
He predicts the legislation will ignite "the beginning of civil disobedience of the most intelligent people in the United States."
Chudacoff sent an e-mail to the Review-Journal that reads in part: "Already Medicare engages in price fixing and limits what doctors can be paid. Now they will further limit the payment on how well doctors 'comply' with the rationing dreams and schemes of Obamacare."
Potential money lost by doctors with passage of the new bill is also the overriding concern of the Clark County Medical Society. Though society President Dr. Annette Teijeiro declined to comment Monday on the potential effects of the new legislation, the society's Web site that urged legislators to vote against the bill said its biggest problem was that it "Creates a new Independent Payment Advisory Board, which would make arbitrary cuts in physician reimbursement with little or no Congressional oversight."
Cheryl Randolph, a spokeswoman for United Healthcare, said the insurer won't be specific at this time about the financial effects of the health care overhaul . The legislation gives insurance companies more than 30 million additional customers but also forbids insurers from placing lifetime dollar limits on policies and from canceling policies because someone gets sick.
With a reconciliation bill moving through the Senate and several state health reform initiatives being considered, Randolph said that "we think that it's premature to speculate on the potential impact on our business ..."
Physicians for a National Health Program, a nationwide group that Thienhaus belongs to, is highly critical of the new bill, saying the "proposal is an insurance company bonanza."
Thienhaus stressed that his position with the group has nothing to do with his position with the medical school.
Like the doctors group, Thienhaus believes that a Medicare-like single-payer approach is the best option for American health care and would save billions of dollars a year by simplifying health administration.
Thienhaus said he disputes Chudacoff's contention that young people will no longer want to become doctors because they might make less money.
"I'll start worrying about that when I see that we have less of the best and brightest students applying to medical school," he said. "They're applying in record numbers."
He said it's doubtful that large numbers of doctors will leave the profession if their pay is slightly limited.
"The alternatives aren't very exciting," he said.
Contact reporter Paul Harasim at pharasim@ reviewjournal.com or 702-387-2908.