How Obamacare Affects Primary-Care Doctors: Charles Cutler

Sophie Novack
Add to Briefcase
See more stories about...
Sophie Novack
Sept. 26, 2013, 4:15 p.m.

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.”

What We're Following See More »
Putin-Linked Think Tank Developed Plan to Influence U.S. Election
3 days ago

A Russian government think tank run by Putin loyalists "developed a plan to swing the 2016 U.S. presidential election to Donald Trump and undermine voters’ faith in the American electoral system." Two confidential documents from the Putin-backed Institute for Strategic Studies, obtained by U.S. intelligence, provide "the framework and rationale for what U.S. intelligence agencies have concluded was an intensive effort by Russia to interfere with the Nov. 8 election."

FBI Relied on Dossier Allegations to Monitor Page
4 days ago

"The FBI last year used a dossier of allegations of Russian ties to Donald Trump's campaign as part of the justification" to monitor Carter Page, who was then a defense adviser to the Trump campaign. "The dossier has also been cited by FBI Director James Comey in some of his briefings to members of Congress in recent weeks."

Russian Bombers Fly Near Alaska
5 days ago
Pentagon Deploying F-35s to Europe
1 weeks ago

"The Air Force is set to deploy its high-tech, fifth-generation F-35A fighter jets to Europe this weekend as part of an effort to assure U.S. allies there who are worried about Russian aggression." The new, state-of-the-art fighters will train with European air units. "The Pentagon noted that the deployment had been long planned, meaning it was not a reaction to recent increasing tensions between the United States and Russia," although a statement noted the move is part of the "European Reassurance Initiative," which began three years ago when Russia annexed Crimea.

Tillerson Meets Putin
1 weeks ago

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.