By Scott Scanlon / Refresh Editor

Dr. Michael D. Merrill, vice president of medical affairs at United Memorial Medical Center in Batavia, is among the frontline physicians treating a growing number of chronically sick patients as the medical field is about to change its insurance regulations.

Merrill, 49, helps run the 131-bed hospital and has a part-time practice in internal medicine. He grew up in the Chicago suburbs and has lived in Amherst for 22 years. He’s a graduate of Dartmouth College and the University at Buffalo Medical School, as well as Columbia University Journalism School.

His best advice to people who want to stay healthy? “Hang out with people who are healthier than you.”

What are some common conditions your patients have?

I tend to see the sicker patients, so it’s congestive heart failure, diabetes, hypertension, emphysema.

Is there a common thread that you see there? Lifestyle? Genetics?

Most of the burden of illness you see, whether it’s smoking or overeating, alcoholism, maybe about half of the disease burden is lifestyle stuff. But another way I see it is diseases of the modern world. You can be as motivated a person as you want, but sometimes you can’t avoid handling diesel particles, you can’t avoid eating too many carbohydrates. Life is so stressful that sometimes people need to self-medicate with nicotine and alcohol. We’re big on personal responsibility but also there’s a setup … modern life structured by economics and technology. It’s the downside of the great luxury we have in the world. You don’t have to get off the couch.

What can people do for these chronic conditions?

Tell them exercise is the fountain of youth. The best 80-year-old I ever saw walked seven miles every day from Cheektowaga to his brother’s house in Lancaster, and back again. He was fantastic. He was sharp in the head and agile, had young-looking skin. I also tell people, ‘Don’t eat bread and potatoes.’ If they’re desperate enough, they’ll listen to me.

How is the new health care law going to impact rural hospitals?

The hospital itself is at risk of losing substantial money if it doesn’t reach certain metrics ... which we find unfair because the average hospital operates on a margin of something like 2 percent.

One of the things we’ve done is create a new affiliation with Rochester General, and we’re trying to share some human capital resources and looking for some guidance on how to go through this.

Accountable care organizations are going to be created. Everybody complains about the cost of health care, overutilization of health care, so much [money] … spent on the last six months of life, but the government doesn’t want to put itself in a position of saying, ‘You can’t have health care at this point.’ So what they’re trying to do is get other people to do it …

Say you’ve got $5,000 per person for this coming year for all of their health needs. Say there’s 1,000 people, so [an accountable care organization gets] $5 million and if you go over that, tough. If you go under that, you keep the money, so you can see there’s some perverse incentives there that I don’t think anybody’s talking about.

Is the health system broken?

It’s a half-regulated free-for-all. This is a chaotic 50 percent free market and 50 percent regulated system that nobody’s designing from any central planning system. We’re putting Band-Aids on problems.

How does a patient maneuver in this system?

The fundamental question is, ‘Do you have insurance or not?’ Beyond that, preventative care. The main thing a patient should do is learn everything they can.

… It’s hard for me to give you general rules, apart from just work with your primary doctor. The thing about primary care is, particularly when someone gets older, you have a lot of chronic diseases and with a 15-minute office visit … every patient that comes into my door could use an hour to talk about all these things.