Editor's note: This fall, The N&O is talking to people about the nation's health care system: what works, what doesn't and what should be done to fix it.

After 18 years as an insurance executive, Ron Howrigon decided to leave the business the night his son was born.

It was late, and the delivery doctor, whose salary Howrigon had worked to undercut in negotiations for his insurance company employer, finally performed a Caesarean section birth. As Howrigon thanked him, the doctor shrugged and said it was his job.

"And then, as he walked out of the operating room, he turned and said, 'The next time you negotiate money away from a doctor, remember tonight. I was the one who was here,'" Howrigon recalls.

Howrigon spent the next three months on family leave assembling a business plan. He never returned to his job at Capital Blue Cross of Pennsylvania, where he held a vice president-level position negotiating fee contracts with doctors and hospitals.

That was five years ago. Now Howrigon, 44, is president of Fulcrum Strategies in Raleigh and works with doctors to win higher fees from insurance companies.

He's watching the congressional debate over health care bills with trepidation. He worries the current health care overhaul proposals will hurt doctors even more than he did in his past life.

"I don't see a single bill that solves the cost problem," Howrigon says. "And the consequences of some bills will solve the problem, but on the backs of physicians."

Howrigon, who has a master's degree in economics, says adding a public option as some congressional leaders have suggested would be especially problematic for physicians.

A public option, in which the government would basically offer an insurance plan to compete with private insurers, would likely reimburse doctors at the same rate as Medicaid and Medicare. In many cases, both government policies pay rates well below a doctor's cost of doing business.

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