In West Virginia, Albert Pilkington III, president and CEO of West Virginia University Hospitals-East -- which includes City Hospital in Martinsburg and Jefferson Memorial Hospital in Ranson -- said there needs to be more focus on home-health services and letting people die at home, which was the norm generations ago.
"We have to change the whole way we treat end-of-life issues," he said.
In an e-mail, Pilkington wrote, "As a Christian, I simply believe families want to take care of other family members. They simply need clinical and financial support to do so. However, the present health care discussion seems based around a socialist concept that the only people that can take care of people is the government."
Hamill, Pilkington and two local doctors agreed that the country's health care system needs to be fixed.
"Anybody that says we don't need reform is fooling themselves or working for the insurance companies," said Dr. M. Douglas Becker, a Hagerstown pediatrician.
Becker said it's uncomfortable watching health care companies spend 15 percent to 20 percent on overhead, while Medicare, a government-run program, spends about 3 percent.
Medicare, Medicaid and Veterans Affairs programs work well, yet partisan politics are fueling a campaign against what some have termed "socialized medicine," he said.
"Call it that, but it's working for them and it leaves them a lot of choice," Becker said. "If you leave it to insurance companies, the rationing is left to ability to pay, and that's unfair."
Dr. Stephen Kotch, chairman of Washington County Hospital's Department of Emergency Medicine, said too many people use the emergency room for primary care.
He said there's a shortage of primary-care doctors, who face enormous debt when they get out of school.
Meanwhile, "reimbursement from Medicare and providers has increased a lot less than their costs," Kotch said. And that, he said, "makes primary care a lot less attractive to go into."
"We treat the doctors like dogs," Pilkington said. "We treat them like criminals."
Becker said doctors make good money by working long hours and doing what others won't do. Some insurance executives, however, get wealthy "by gouging the public for the services they need to have," he said.
Hamill, Pilkington and Kotch said they support tort reform, which sets a limit on liability awards in medical malpractice lawsuits.
"There won't be any meaningful health care reform without it," Kotch said.
Several years ago, many Western Maryland physicians banded together to press the state to rein in the cost of medical malpractice insurance. They said exorbitant premiums were forcing doctors to flee to other states or leave the profession.
State lawmakers made changes, but not as many as the doctors wanted.
"Why we have to take a hit and lawyers don't is criminal," Pilkington said. "It creates a culture of defensive medicine," with doctors ordering expensive tests on patients only to shield themselves from blame.
Washington County Hospital is part of a physician-hospital organization planning a clinical integration program through which more than 200 physicians would collaboratively evaluate, treat and monitor patients, and control costs.
The organization, called TriState Health Partners, was formed in 1994. It has components that focus on disease management, case management, pharmacy reviews, health coaching and other areas.
"The mind-set needs to be to improve the health of the community," which would lower health care costs, Hamill said.
Becker said President Obama hasn't been forceful enough in fighting for his health care vision -- a contrast to President Lyndon Baines Johnson's successful push for Medicare.
Instead, opponents are keeping the populace scared, Becker said.
Pilkington said politicians are afraid to anger senior citizens, the country's largest voting bloc.
"I'm not an Obama fan," he said, "but I at least have to pat the guy on the back for at least trying."