Readers' and Author's Responses to "We All Need Healthcare; Who Needs 'Insurance'?"

Barbara Bryan; Joe Polaschek; Stephen Rinsler, MD; John Hunt, MD; Patrick Martin, MD, FAAP, CPE; Percy G. Wood; Georganne Chapin, JD, MPhil


October 17, 2007

To the Editor,

Finally, someone has written what I have said for years: that America's resources are better spent offering healthcare than that third-party paper shuffle we call insurance -- whatever its terms and stated benefits.[1]

My suggestion has been to keep public health facilities open around the clock for all but major health concerns that would transfer to hospitals or other systems.

Hospitals receiving increasingly fewer nonpaying patients should greatly appreciate the triage and diversion of potentially high-cost, high-risk, often indigent patients. As their costs go down, healthcare and insurance costs should plummet in tandem.

It can happen if care quality is what it can and should be -- not a wink and nod to rather than genuine competence in the public health sector -- and residents, scarcely trained medical personnel, adjuncts, and even senior personnel, are not totally cloaked in immunity from preventable errors and omissions.

It works if insurance companies, hospitals, and other care facilities do not keep costs artificially inflated, if they pass savings on to taxpayers who, in the end, agree to cover healthcare costs for the working poor or totally dependent citizen because it is the most cost-effective way to do the right thing.

Barbara Bryan


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

To the Editor,

I would like to thank Ms. Chapin for speaking out with a voice of reason in regard to the "nonsystem" of healthcare delivery in our country.[1] I've been involved in the development and operation of various aspects of managed healthcare for over 30 years. I began with high hopes for this model, and along with it, the "competition theory" of economics -- that competing forces in the insurance industry would not only be able to provide healthcare, but would be able to keep the costs low as well.

Well, it became very clear as we progressed that this model just doesn't work. Dollars destined for healthcare delivery are dispersed to many unnecessary and redundant elements within the industry, and the "plans" continue to reduce the coverage and access to healthcare. The insurance companies and payers state that they will not interfere with the healthcare delivery process and with the physician-patient relationship, but they do so blatantly by setting up barriers to access and payment. (I work with one physician who has had difficulty getting reimbursed for the second baby in a twin delivery and not being reimbursed for even his cost of vaccines.) The Utilization Management departments are a pseudonym for cost containment and attempts to second-guess the physicians in their treatment plans without ever even seeing the patient.

The only rational and equitable approach to healthcare delivery is a single-payer, universal healthcare delivery system. Everyone would have access to quality healthcare from the providers in their community at considerably less cost than currently.

Joe Polaschek
Salinas, California


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

To the Editor,

First, I agree that the current "for-profit" mentality is critically wrongheaded when seeking to provide good medical care for our nation's population.

Second, I agree that elements of the Medicare approach applied generally would be superior to the current profit-oriented one.

Fundamentally, however, we need to specifically and explicitly set out the basic principles for eliminating economic barriers to necessary care. This would include provision for funding for medical services, hospital care, home care, and nursing home care, including therapeutics. The avoidance of stupid utilization of expensive services when less expensive options exist should also be built in.

One thing not mentioned that I see as very important is to specify what falls under "healthy living/lifestyle" vs medical care. The former is completely under the control of the individual, whereas the latter benefits from the advice of trained clinical professionals. For example, a person is responsible for eating and exercising properly so he/she avoids significant obesity, and beyond that, for engaging in productive meaningful activities to ensure that his/her life is worthwhile and satisfying. They don't benefit from a medical doctor as much as from people who are experts in nutrition and exercise, and from mentors who can empathize and advise them in a meaningful way.

Until we unload these "health" issues from the medical sphere (and think in terms of illness care rather than healthcare), we will continue to have a whole array of expensive inappropriate solutions.[1]

Stephen Rinsler, MD
Arden, North Carolina


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

To the Editor,

I have long thought that health insurance is clearly the problem, not the solution, to our nation's healthcare woes. Therefore, I read with excitement the title to Ms. Chapin's editorial: "We All Need Healthcare; Who Needs "Insurance"? I was thrilled that perhaps someone was finally realizing that health insurance is not remotely synonymous with healthcare. But then I read the editorial and found that she, like the politicians, promotes entirely the wrong solution.

Insurance of all kinds is designed to protect against financial calamity in the setting of an unfortunate event. Fire insurance doesn't bring the fireman. Flood insurance doesn't stop the flood. Health insurance shouldn't bring the doctor or be expected to stop disease. Health insurance should simply prevent profound financial hardship in the event of an expensive illness. Bill Gates should not be forced to have health insurance for any reason. And the average American should not be required to have health insurance to cover the cost of an ear infection. Given everyone's fully justified hatred of health insurance, universal health insurance is not a goal anybody older than a child should be wishing for.

I am one doctor who detests health insurance and am convinced that I should have nothing to do with any patient's insurance company. But more importantly, I will never accept being forced to work for a government-run healthcare system. Doctors are fleeing Medicare for excellent reasons derived from a complete lack of free-market pricing, customer service, and apportionment of resources. If Ms. Chapin is eager for socialist medicine, what method does she plan to propose for the government to force doctors like me to play? The threat of "creeping Stalinism" is real.

The current health insurance system consists of hundreds of little collectivist (and effectively socialist) entities, with all the undeniable failures in supply-demand balance to which socialism invariably leads. Socialization of medical care as Ms. Chapin proposes is just as evil, shortsighted, and foolish as the concept of universal health insurance. Medical care is too important to us to risk further socializing it. Sooner or later, socialism always fails, in the process demolishing the host economy (thereby making everyone poorer and less able to afford anything at all). The current system is failing precisely because of the component of socialism within it. Foisting on the free citizens of the United States, a single government socialist system akin to Medicare certainly doesn't fix that problem. Don't forget that Medicare is going bankrupt in about a decade!

What is the solution that will lead to the financial health of our healthcare system? First, eliminate the corporate tax deduction for providing health insurance to employees. Then the companies may choose to pay to the employees the money not wasted on health insurance; the employees can save that money for healthcare expenses in a Health Savings Account (HSA; or buy health insurance if they wish), and the health insurance companies will have to work for their clients instead of vice versa. Then let the free market do its magic while we ignore the rants of the socialists who say it won't work. It most certainly will.

Healthcare is maximally available when the free market is used. The free market creates a wealth of healthcare resources. Yes, the government schools will need to be fixed to prepare patients to make their own health decisions with their money, know when they need doctors, and use preventive care in order to save money and maintain health. Yes, HSAs should be encouraged for a transition period because Americans aren't used to medical freedom. Yes, catastrophic health insurance should be encouraged to prevent financial calamity. Yes, almost all medications (except antibiotics) should be available over-the-counter to fairly compete. Yes, people will learn, grow, and thrive on the freedom the way Americans always do.

Let's not forget the lessons of the 20th century: Socialism has failed in the largest human experiments ever undertaken. These experiments have so far cost millions of people their lives (under Stalin's and Mao's socialist programs). No Human Investigation Committee or ethics department in the country would approve an experiment in Socialism considering the huge risks to life and dignity so apparent in previous experiments.

The voters of the United States must now and forever get it out of their heads that they have any right to force other Americans to participate in a socialized medical system. To enact socialized medicine, just like everything else that is socialist, requires force and threats of punishment. This is simply evil. We won the Cold War, but the socialists in our own country are destroying us from the inside. They are now winning on the home front, with the frontline trenches being healthcare. Yes, the current health insurance paradigm needs to be abandoned. Yes, healthcare needs to be fixed. However, the American way is to encourage freedom, not socialism. Freedom is the fix.[1]

John Hunt, MD
Pediatric Pulmonologist, Allergist/Immunologist
Charlottesville, Virginia


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

To the Editor,

I write to inform of my joy at viewing your recent Webcast on the subject.[1]

In my neck of the woods -- St. Kitts and Nevis, a small (50,000 population) Caribbean island nation -- we have arrived at a point in our development when chronic noncommunicable diseases dominate the epidemiologic profile. With rapidly escalating healthcare costs, the populist knee jerk reaction is "insurance."

We follow your politics, including the machinations surrounding healthcare, with great interest. Fortunately, we benefit (or should) from your experience in that to attempt to meet the costs of catastrophic care for all is a prescription for financial ruin. Hence, the emphasis, as was poignantly indicated in the program, must be placed on care -- healthcare not sickness care.

There is no need to reinvent the wheel because health sciences solve major problems with good, old-fashioned strategies, such as prevention, health promotion, population wellness (disease) management, and guidelines.

One other strategy that I am pushing is physician management because all medical costs start with a physician's order. Because we physicians are a recalcitrant lot, if required, we have to be brought kicking and screaming to the consultation table where all health stakeholders sit and speak equally. The agenda was outlined in your presentation, ie, switch the emphasis to care within the framework of a pooled benefit-risk regimen that is portable, user-friendly, and as permanent as the taxes allow.

I believe that the Medicare model will eventually rule but not until profiteering is intercepted by political will (oops, therein lies a problem). In the interim, healthcare will be considered a product subject to market rules rather than a service, a right, and a social good. Besides, social good smacks of the S word -- socialism. The notion of universal access to and sharing (another S word) of the benefits is inimical to the profit motive, whereby once premiums are paid, service and payouts become scarce. Expect a raging fight to maintain the status quo.

I was privileged to be trained in the United States; I am confident in the peoples' sense of fairness (equity). I expect a rebellion against the current way of doing things because it is patently un-American to shut the healthcare door to hard-working people and their dependents. When the options are explained, the people will choose "high-touch" care over low-access, high-technology care even if their taxes are increased.

Keep the debate robustly apace on Medscape; a well-informed populace can be trusted to make the right political decisions.[1]

Patrick Martin, MD, FAAP, CPE
Chief Medical Officer, Ministry of Health
Basseterre, St. Kitts and Nevis


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

To the Editor,

I usually reserve this for the airplane people when they talk about Insurance. However, because you recently wrote: "The health insurance model is flawed because it depends on people falling between the cracks after they pay their premiums and before they collect their 'benefits.' Rather than insurance, providing healthcare to everyone would cost less and deliver more in the long run."

I point out that "Insurance is the spreading of risk." You'll note that there is no "Big Rock Candy Mountain" spewing unlimited goodies. The objective is that all the premiums cover all the payouts plus a little something for the companies.

You do have the right idea in that insurance is not the answer to the growing healthcare problems that persons face, especially the elder set, such as myself.

However, I cannot see how "universal healthcare" can be provided without a universal picking of the pockets of the citizens, or a plundering of the medical establishment of their monopolistic powers and practices.[1]

I do wish you all the luck, how some ever.

Percy G. Wood
Roswell, New Mexico


  1. Chapin G. We all need healthcare; who needs "insurance"? MedGenMed. 2007;9:22. Available at: Accessed October 9, 2007.

Author Response

Not surprisingly, since the publication of my editorial, several presidential candidates have released healthcare proposals that, indeed, entail strewing the same old red tape over even more people.

The candidates, with no serious consideration otherwise, cling to insurance as the vehicle to deliver us from the worsening national statistics about the growing burden of chronic disease and the ever-increasing number of people with no coverage. None has explained how costs will be controlled, what kind of new bureaucracy will need to be created to manage an even greater number of people entering and leaving the system as they gain and lose coverage, or how an individual mandate to purchase insurance will be enforced (What -- you didn't buy insurance and you expect us to fix your broken leg? The state will have to impound your body!) Meanwhile, we can't even get a children's health program funded, although you can't find a single politician who'll say that all youngsters (and of course oldsters -- but not those in-between) don't deserve healthcare.

We owe it to ourselves to be highly critical of sound-bite solutions to the high costs and complexity burdening the current insurance-based model. Somewhere along the line we decided that universal basic education and literacy were a public good, not a socialist plot. Similarly, universal basic healthcare -- which protects the public from communicable diseases, allows parents to work and care for their children, and reduces the misery and cost of untreated illness -- is a feature of all modern capitalist democracies. Although nobody can argue with the value of prevention in the form of healthy eating and exercise, such pursuits do not obviate the need for medical services, nor for developing sensible priorities and policies to minimize waste and maximize the distribution of benefits.

Perhaps it will take a public health 9/11 -- a disease pandemic, say, or an economic collapse -- to give politicians a mandate for true reform. Or perhaps the current system will simply implode when 1 out of every 2, rather than 1 out of every 3, nonelderly Americans go without insurance some time during a 2-year period[1] and the lines at the emergency departments grow even longer. Perhaps then we will have the courage to say "enough!" to the insurance industry, the drug industry, and others who profit from the current system, and to put into place a system that promises quality, cost-effective medical care to the entire population.

Georganne Chapin, JD, MPhil


  1. Families USA. Wrong Direction: One Out of Every Three Americans are Uninsured. Washington, DC: Families USA; September 2007. Available at: Accessed October 9, 2007.

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