Readers' Responses to the Webcast Video Editorials Entitled "The American Healthcare 'System' in 2005" -- Parts 1 and 2

Therese M. Doyle, CNM, MS; Murthy Andavolu


March 24, 2005

To the Editor,

I enjoyed your recent article highlighting the out-of-control healthcare costs in the United States.[1] It is mind-boggling that politics often stand in the way of better utilization of advanced practice nurses, considering the excellent outcomes that can be achieved with a reduction in cost for the consumer.

As the director of a nurse-midwifery service in suburban Chicago, Illinois, I see this on a daily basis. Many esteemed physicians and nurse-midwives have published articles demonstrating how healthcare expenditures can be reduced while achieving outcomes that are equal to or better than physician care. I know that the politics surrounding results like these are enormous, but it is unfortunate that in this country, considering the state of healthcare, that politics rule the day.

At some point, we need to begin to model the Western European countries where midwives deliver the majority of the OB [obstetrician] care. I am attaching a graph that I developed for a recent presentation that I gave discussing this very topic. It is a work in progress, but you can see a trend in which the countries that employ midwives have much better infant mortality rates and spend less money to achieve these improved outcomes.

If you know of any forums in which I can continue to try to get this message across to policymakers, physicians, etc, please let me know.

Sincerely yours,

Therese M. Doyle, CNM, MS
Midwest Midwifery, LTD
Bloomingdale, Illinois


  1. Lundberg GD. The American healthcare "system" in 2005 -- part 1: context. Medscape General Medicine. 2005;7(1). Available at: Accessed January 21, 2005.

To the Editor,

To solve this puzzle of healthcare, an analysis of the reason(s) for the chaos in the American healthcare "system," or lack thereof,[1] is in order. A multitude of self-interest groups have entered the fray, the minute the American healthcare consumer has given up his/her rights to a third-party payer. This is not the case in any other product or service industry in which the manufacturer and/or seller markets the goods or services to a customer who directly arranges for the payment at or about the time of the sale. But the public has a very different approach to obtaining a service from the healthcare industry as opposed to any other sector of the economy, and has abdicated its rights to the third-party payer in the healthcare market -- Little wonder that the healthcare industry springs up unpleasant and unhealthy results. For the same reason, the payer and all associated parties other than the consumer are in charge. Once the driver's seat is given up to the third-party payer, the patient's destination and the driver's goal are in 2 different directions. Somewhere along this journey, the consumer, instead of taking over the wheel back into his/her hands, has decided to alight at the lawyer's office. With the lawyer in the backseat, the risk for the insurer and hence the premium for the patient have gone up. This has resulted not in a free market, but a free-for-all market!

If free-market economy is what made America the greatest country in the world, it is not difficult to imagine what the opposite of free-market economy can do to the health of this country.

Murthy Andavolu
Rancho Mirage, California


  1. Lundberg GD. The American healthcare "system" in 2005 -- part 2: who is in charge? Medscape General Medicine. 2005;7(1). Available at: Accessed January 28, 2005.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: