Dr. Charles Cutler has lived and practiced medicine for his entire life in the same county he grew up in. He went to college, medical school, and completed his residency in Philadelphia. He’s been an internist at a small practice in a small town outside Philly since 1979, although—he’s careful to point out—he moved to a different office a block away in 1986. “I start to perspire incessantly when I leave” the neighborhood, he says with a laugh.
Cutler, 64, jokes that he has trouble with change, but really, he says, staying put has given him a sense of permanency about his practice. This community connection makes Cutler particularly optimistic about the changes coming with the Affordable Care Act. “The law is the best thing for my patients throughout my entire career.”
Internal medicine involves a lot of screenings and preventive care, which, before the ACA, many of his patients would simply forgo. His is a working-class mill town, although much of the heavy manufacturing has closed down, and many blue-collar workers struggle to find jobs. They are proud people who don’t like to take things for free, the doctor says, so “they tend to hold back when they shouldn’t on their medical care.” This means putting off tests and prevention—and then relying on the emergency room.
Here Cutler sees dramatic improvements as a result of the ACA, in both the lives of his patients and the cost of care. Because more people will be insured, they will be inclined to visit the doctor regularly, and because the law requires most health plans to cover preventive services, he expects more of his patients to come see him before an ailment gets serious. “It’s so cost-effective to find something early in a screening when it’s small and easily cured rather than waiting until it’s big and incurable or expensive to deal with.” Often patients don’t know whether a problem is minor or major, and they’ll end up going to the ER, which is very expensive and taxes the system. “It results in the ER filled with subacute or chronic conditions; when people with really serious situations come, we get bottlenecks,” Cutler says.
His office may see a small initial increase in patients under the health care law, but Cutler says the system will adjust for it. “We’ll have more patients early, but fewer with real advanced illnesses that take up a lot of resources…. If we screen more people and pick up illnesses early, at the other end there will be fewer patients suffering from bad diseases.”