To the Editor,
Yes, we anxiously await a single-payer system, such as Medicare, which year after year lowers our reimbursement and denies us alternate sources of income. Competition is just as good in medicine as in any other enterprise.
S. M. Doubrava, MD, JD
Las Vegas, Nevada
onlymax@cox.net
Author's Reply:
Dear Dr. Doubrava,
Some doctors and others are happy with the US system of profit-based healthcare. Millions who have no coverage are not happy with it. We have been brainwashed and told erroneously that our healthcare system is the best in the world. Although there are many dedicated professionals -- nurses and doctors, researchers, and hospital officials -- still we are rated far below every other industrialized country (number 37). The statistics are startling, for example, that we have less likelihood of surviving a kidney transplant: It is 6% better in New Zealand, 13% better in Canada, and 4% better in the United Kingdom and Australia . . . better treatment of asthma and prostate cancer . . . rated below 41 other countries in infant mortality. The best healthcare in the world is just one of the myths that we need to understand and refute.
New Zealand is rated by the World Bank as having the best business climate in the world because of its comprehensive, fairly financed healthcare system. The World Economic Forum names Finland, another country that has a seamless and fairly efficient system ("Paying More, But Getting Less[1]" article on the Center for American Progress Web site). We want our doctors to receive a just compensation for their work, not to be relegated to working for the government. We want them to be treated with respect, but we also want comprehensive, excellent healthcare for all showing respect and care for the diverse peoples of the United States.
Thanks for your letter,
Marilyn Clement
Healthcare-NOW!
Reference
Daschle T. Paying more, but getting less. Center for American Progress. November 9, 2005. Available at: https://www.americanprogress.org/site/pp.asp?c=biJRJ8OVF&b=1170701 Accessed March 31, 2006.
To the Editor,
I never thought that I would agree, but it is past the time for single-payer insurance.[1]
Robert Shearer, MD
rashearermd@comcast.net
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Thank you for your letter. You are right. We need to hurry before we waste more money, remove more millions of people from the rolls, and possibly bankrupt the nation. A single-payer system is the way to go. Spend less; get more.
Marilyn Clement
Healthcare-NOW!
To the Editor,
I don't disagree with many of the problems, ie, ridiculous amounts of money wasted on insurance company reimbursement games, etc, noted in this editorial.[1] However, before you jump to a single-payer, government-based system, why don't you poll the many Canadian physicians who have left Canada to practice here or elsewhere to see whether such a system will be a panacea for these problems.
Respectfully,
Robert Darragh, MD
Indianapolis, Indiana
rdarragh@iupui.edu
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dr. Darragh,
You may find it interesting that more doctors are going back to Canada from the United States than are coming here. I don't expect that there is such a thing as a panacea to be found in the annals of healthcare -- just a better way of providing healthcare for everybody in the country, helping our economy, and providing a good livelihood for the doctors. It is a decision whose time has come. Here's a Web site that may be interesting to you: Healthcare-NOW! (ie, the current healthcare turmoil in Canada).
Thanks for your letter,
Marilyn Clement
Healthcare-NOW!
To the Editor,
A single-payer system is incompatible with human nature and our free-market capitalistic economic system.[1] It is a soft totalitarianism at the expense of patients and doctors. When the flow of patients is from the United States to Canada, the single-payer system will be appropriate.
Sincerely,
G. S. Miller, MD
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dear Dr. Miller,
There is already quite a flow of patients leaving the United States to get healthcare in Canada, South Korea, India, France, China, Mexico, Singapore, and other places where they can afford to get excellent care. Check it out!
Marilyn Clement
Healthcare-NOW!
To the Editor,
Marilyn Clement[1] argues that physicians are slaves to payers. Her medical emancipation proclamation encourages them to become, in effect, government employees. She promises that they will be highly paid and influential. Doctors need only look to the underpaid physicians toiling in the outdated facilities of the Veterans Administration to see the implausibility of this promise. Stunningly, she calls single-payer a conservative solution!
Currently, half of healthcare is paid for by government, an already unsustainable, unfunded mandate. The uninsured and the cost of healthcare to corporations are real problems. The solution may lie in giving power to the people in the form of market solutions, such as Health Savings Accounts (HSAs), as President Bush will point out in his State of the Union address. The ever-declining price of Lasik surgery is a good example of what happens to prices when the market is allowed to work.
Terry Nugent
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dear Mr. Nugent,
The old, false claims that we are talking about doctors working for the government are easy to trot out. We have explicitly noted that we are not talking about that kind of system. That is the kind of system that is practiced in the United Kingdom. What we want is a publicly funded/privately delivered system with the doctors in the decision-making pool along with the nurses and hospitals, patients, and advocates concerning prices for procedures and equipment.
Do we want someone in charge other than the profit-satiated medical industrial complex? Absolutely, we do. Do we want corporate control of our healthcare or public control of our healthcare? The answer is, of course, public control. We can still vote in this country (hoping that our votes will be counted). That means that we will have a bit of leverage over the decisions that get made. With corporate control we have no decision-making power at all. Our claims and our needs are rejected and denied on a daily basis. We are sick and tired of being sick and tired -- and ignored.
Thanks for your letter,
Marilyn Clement
Healthcare-NOW!
To the Editor,
"Emancipating the Doctors[1]" puts it mildly, as the present chaotic situation with Medicare D/Medicaid makes obvious.
The problem with healthcare is that it is profitable in this country and generates constituencies.
We saw this in the responses to several 20th-century attempts. These constituencies have included the AMA [American Medical Association] itself (years ago), the corporations that bought the "Harry and Louise" ads, and Pharma. Now we have all the Medicare D companies, which will probably see mergers and buyouts, to add to that list. They all will demand some sort of payoff before a single-payer system can take place.
David L. Elliott, PhD
College Park, Maryland
d.elliot@ieee.org
P.S. My personal interest? At 73, I am one of the oldest severe hemophiliacs in the United States (and researcher in hematology for a few years). If it were not for the large insurance pools of the Federal government and of the universities that later employed me, I would have no health insurance.
Reference:
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dear Dr. Elliot,
Thank you so much for your letter. Yours is one of the millions of cases in which it is clear that the government can do a better job. When we get to a Medicare for All-type system, we will be spending only 3% for administration vs almost 30% under insurance companies and HMOs [health maintenance organizations]. If for no other reason, paying this huge excessive administrative, profit, advertising, lobbying cost is a terrible business decision on the part of our country. We need to be more efficient and serve all of our people at the same time.
Thanks for your letter,
Marilyn Clement
Healthcare-NOW!
To the Editor,
Although I think that some type of universal healthcare is going to come into being, I strongly disagree with the utopian ideas given by Ms. Clement.[1] She said that the doctors would be "liberated." She obviously has no knowledge of the restrictions imposed on physicians by the government through Medicare. She claimed that doctors would have an excellent income. Does she have any idea of how low the reimbursement that physicians receive for their Medicare patients? I am a retired orthopaedic surgeon and am now a user of Medicare. When I was in active surgical practice, I used to receive about $3000 for a total hip replacement. Today, an orthopaedist is lucky to get $1500. When I get the EOB [explanation of benefits] for the care that I receive from my physicians, I am embarrassed at what Medicare pays them.
Doctors would not be "emancipated" and would have no more chance of being on a decision-making panel then than now. The decisions are made by the hospitals, not the doctors.
I do not foresee a universal healthcare scheme being any different from the current Medicare system. The only difference would be that because all patients would be covered by the same insurance, doctors could not refuse to accept "Medicare" patients as they can and do at present.
All one has to do is to look at the Canadian and British systems to predict what a similar system would be like in the United States. There would inevitably be long waiting lists for elective surgery, and those who could afford to buy private insurance would do so in order to receive prompt care. This is occurring in Britain, Ireland, and Canada despite the fact that these countries have "universal healthcare."
John W. Thompson, MD
Lake Oswego, Oregon
jthomp8043@comcast.net
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dear Dr. Thompson,
There will always be those who have plenty of money and want to go to the head of the line. But, if we were to go to a national single-payer system, those people would be in the same pool as the 50 million or so who are not getting healthcare coverage at all. Read more about the changes in Canadian healthcare here on Healthcare-NOW!
Thanks for your letter,
Marilyn Clement
Healthcare-NOW!
To the Editor,
I graduated from medical school in 1960 and have been in private practice since 1966. I've seen the evolution from physicians being directly responsible to their patients for providing medical care and patients being directly responsible to their physicians for payment to the current mess of third parties endlessly intruding in this relationship to the detriment of both patients and physicians. Although I have no definite plans to retire, it probably won't be too many more years, so my vested interest in seeing the system improved is more as a future consumer than provider.
Ms. Clement[1] has valid concerns about HMOs [health maintenance organizations] and insurance companies telling physicians how to practice. This, which is in effect, substitutes fiscal policy for medical judgment. She refers to a "much-improved Medicare for All system." The problem with this answer is that Medicare is the absolute epitome of all of the faults and evils that she describes: de facto restrictions on length of hospital stays, drugs to be used, what treatments can be administered, etc, etc, etc, and completely unreasonable amounts of paperwork. Add to that retrospective reviews and the threat of severe penalties for noncompliance, even if the noncompliance is inadvertent. When did the government ever actually simplify and truly improve on anything? What reason is there to think that a national health plan will not infinitely compound the problems that we already have? I can only see more layers of micromanaging bureaucrats and an endless increase in the already mountainous layers of paperwork, combined with even more inadequate payment to practitioners.
Simply put, Medicare is already ruining the practice of medicine, and many insurance companies are following Medicare's lead. Worst of all, the word is out, and many of our best and brightest college graduates are no longer looking at medicine as a top career choice.
I was fortunate to have been in a primary specialty necessitating minimal contact with Medicare. I now limit to a secondary specialty and no longer see a large volume of patients. I believe that I am still making a positive contribution to the local medical community, and the next nearest physician who my patients could see for the same services is 120 miles away. If 50% of my patients were on Medicare, as is typical for internal medicine in our area, I would not be able to generate enough income to have a financially viable practice and would have completely retired at least 6 years ago.
Although I certainly compliment Ms. Clement for her genuine concern, I most emphatically cannot agree with her solution. I could offer some suggestions, but I don't believe that space permits here.
The most terrifying words in the English language are, "I'm from the government, and I'm here to help." -- President Ronald Reagan
Joseph T. Morgan, MD
Coos Bay, Oregon
drmorgan@harborside.com
Reference
Clement M. Emancipating the doctors. MedGenMed. 2006;8:11. Available at: https://www.medscape.com/viewarticle/520863 Accessed January 13, 2006.
Author's Reply:
Dear Dr. Morgan,
I would say that the most terrifying words may be, "I'm from Halliburton, Humana, or Bechtel; or Blue Cross; or Enron; or Unical, and I'm here to help." We are pouring money by the hundreds of billions into corporations such as these with absolutely no control over their excessive profits and spending, lobbying, and advertising. However, our people are not covered for healthcare. I would prefer a system in which I at least had a vote.
Thanks for your letter.
Sincerely,
Marilyn Clement
Healthcare-NOW!
Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: glundberg@medscape.net
© 2006 Medscape
Cite this: Readers' Responses and Author's Reply to "Emancipating the Doctors" - Medscape - Apr 14, 2006.
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