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In N. Virginia Exurb, the Holdouts Are Unmoved

By Philip Rucker
Washington Post Staff Writer
Thursday, September 10, 2009

The doctors and the patients they treat at a community hospital in Stafford, in Northern Virginia's exurban frontier, agreed with President Obama's assertions Wednesday that the national health-care system is broken, and most agreed that all Americans should be covered.

But even as Obama presented his ambitious health-care reform agenda in his clearest and most urgent terms yet, he failed to win over some people who for months have opposed progressive elements of his reform plan or who have been uneasy or plain confused about others.

"We do need something," David Varrelman, a longtime police officer, said from his hospital bed as he recovered from gall bladder surgery. "But they've got to come up with something that's going to be paid for and that's not government-controlled."

Earlier in the day, Varrelman, 77, said he could support Obama's efforts if the president made some bipartisan compromises, such as abandoning his proposal for a government-run insurance option. Varrelman likened the public option to "a camel with his nose in the tent. If you let the camel's nose in, before you know it, the whole camel's in the tent, the whole [health-care system] will be government-controlled."

The Stafford Hospital Center opened in February in the heart of Stafford County, a mostly conservative jurisdiction about 45 miles south of Washington populated with exurban commuters and rural farmers. The nonprofit hospital offers a prism through which to understand some of the forces still plaguing Obama's health-care efforts.

In Stafford, as in other Northern Virginia exurbs, Obama had surprising electoral success during last year's presidential contest, outperforming recent Democratic candidates and attracting nearly as many votes as Sen. John McCain (R-Ariz.). But Obama's personal appeal in the region has not translated into support for health-care reform, according to a Washington Post poll showing that voters here mirrored those nationally in their divide on the issue.

Overall, 49 percent of residents of Northern Virginia's exurbs called health-care reform a worthy effort, and 48 percent said it would do more harm than good. Yet although a majority of voters here said they were satisfied with their insurance coverage and the quality of health care they receive, census data show that roughly 15,000 residents of Stafford, or 13.2 percent of the population, have no health insurance.

This fact weighs on doctors at Stafford Hospital Center, which treats a steady flow of uninsured patients in its emergency department.

"The national health-care system is already in place, and that is to go to the emergency department," said Shin Sato, the hospital's emergency medical director. "A sore throat or bruised ankle could easily be seen by a primary-care physician, but we see them, and it overwhelms the emergency system."

J. Thomas Ryan, the hospital system's chief medical officer, said that the health-care system is "broken" but that the challenge is fixing it in an affordable way. He said he was encouraged that Obama was including tort reform in his proposal.

"We wholeheartedly support universal access to medical care, but we have to determine if it's an MRI for every time a patient has an ache in their knee or a CAT scan of their head every time they have a headache," Ryan said. "We cannot take the expectations of today's health-care system and hand that to 46 million new people."

In the emergency waiting room Wednesday night, patients had mixed reactions to Obama's speech. As the president told stories about people who languished with no health insurance, Maureen Schmied, waiting with her injured teenage son, grew agitated. The 42-year-old mortgage broker said she fears that a government-run system would be more inefficient than the current system.

"My blood pressure is up," Schmied said. "I'm livid. For every story he tells about somebody who does not have insurance, there's one you can tell about somebody who wouldn't get treatment because the government wouldn't allow it. For every tic, there's a tack."

Asked midway through the speech whether she agreed with any elements of Obama's plan, Schmied shrugged: "Not yet."

"He sounds good and is trying to paint a pretty picture, but it's not an exact science," Schmied said later. "How is the country going to pay for it? We're still knee-deep in the recession. We haven't fixed the economy, but here we're going to take on more debt."

Upstairs on the hospital's second floor, a young couple celebrated the birth of their daughter, Makia, but lamented that they rely on Medicaid for coverage. The father, Aquan Chapman, 18, said he supports Obama's agenda.

"I think about it sometimes," he said. "If I get in an accident, will somebody pay for it and help me out?"

Cecil Nelson, 46, a Stafford contractor who opposes Obama's reform efforts, watched the speech in its entirety as his wife saw a doctor about pain in her side.

Obama "explained a lot of things, yes," Nelson said. "But as far as changing my mind? Not really."

Polling analyst Jennifer Agiesta contributed to this report.

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