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By Nicholas Emery

Money is best spent by those who earn it. I am a health care professional who graduated from the University at Buffalo in 2008. My career has since paralleled the implementation of the Affordable Care Act. Many people still have not felt the effects of publicly run health care, but as state exchanges are poised to open on Oct. 1, they will.

I split my practice between public and private clinics and I cringe when I think of this paradigm shift in health care, because of its sudden impact. Patients in my private office are focused only on what they need because they bear the cost of it.

My patients whose care is paid for with public money have an entirely different outlook. These patients are less concerned about what they need and more about what they can get. When you separate the cost from the service, you also remove the patients’ awareness of what they are actually having done.

Most of these patients start their appointments by asking me, “What are we going to do today?” Unlike my private patients, there is less interest in maintaining the treatment provided. When treatment is paid for by someone else, repairs can also be paid for by someone else. Public resources are not unlimited, but when patients have no part in paying for them, this is the interpretation.

These comparisons are not indictments of the people I treat but reflections of how public and private funding changes patients’ perceptions of their health care. As public funding increases, I expect patient perceptions to follow suit, as I have discussed. On my side this is discouraging. On the patient’s side it will be maddening.

So far, the Affordable Care Act has leveled most of its impact against insurance companies and providers who have been restructuring their worlds. The full effects will start to sink in with the public in the near future when people need to buy insurance through exchanges or renew their existing policies with skyrocketing premiums.

The cynic in me thinks this mess is by design. Certain organizers cannot wait to point out that obviously private funding for health care alone didn’t work. Now we know that a mix of public and private doesn’t work either. Only then will it be “clear” that public funding alone is the only viable way to pay for medical care in America. All I can do at this point is conserve what I earn and see a few more patients.

Nicholas Emery of Rochester is a health care professional.