A Reader and Author Respond to "Getting Control of Health Costs -- For Real"

J.D. Smucker, MD; Michael Dukakis


December 10, 2007

To the Editor,

I wholeheartedly agree that healthcare costs must be curtailed.

I wholeheartedly disagree with Governor Dukakis' assessment of the other industrialized nations' healthcare systems providing "pretty good" quality.[1]

I could cite numerous examples of systems in which these "pretty good" systems fail. Scandinavian healthcare is totally socialized, but now they're even starting to add copays, etc, too. Consider the 16-year-old who bled to death on the evening after her tonsillectomy, in a large-city Norwegian emergency department, because no physician would come to evaluate her, despite multiple requests from nurse practitioners. No physician was even on-site, at the hospital.

The best of these industrialized countries' systems is supposed to be Canada's. Canadians would love to have our system, and they cross the border for medical attention, whenever they can afford it. This is especially true when they are faced with serious illness.

Curtailing government bureaucracy and laws to diminish malpractice awards would certainly remove a significant percentage of medical costs. If the government wants to throw money at healthcare, it should be in the form of easy-access healthcare clinics to diminish indigent care in our emergency departments and hospitals. Another good use of finances would be health education for the poor, such as those uninsured or on Medicaid, etc.

Government management of healthcare as a public utility would certainly fail to provide the quality of care to which Americans are accustomed. What the government has already done has driven many of our best physicians from the practice of medicine and has discouraged young people from seeking a career in medicine. I remain concerned as to who will care for us, as we age.

J.D. Smucker, MD
Internal Medicine
Columbus, Ohio


  1. Dukakis M. Getting control of health costs -- for real. MedGenMed. 2007;9:55. Available at: Accessed December 3, 2007.

Author's Response:

Whether Dr. Smucker likes it or not, virtually all of the advanced industrialized countries in the world provide their citizens with comprehensive healthcare at one half the cost per capita that we do. Also, their health outcomes are a lot better than ours.

Canada, while it has a good system, is by no means the best in the world. There are a number of others both in Europe and in Asia that provide excellent care much less expensively than we do. Although Norway may have its problems, compare them with those of the 47 million Americans today, overwhelmingly working people and members of working families, who have no health insurance at all! Furthermore, the suggestion that Canadians are pouring over the border to get American healthcare is a myth that has been disproved repeatedly. I have talked to a lot of Canadians over the years. I have never met a single one who would swap his healthcare system for ours.

What Dr. Smucker and his colleagues have to consider is whether they want to continue to deal with a bewildering, bureaucratic, and expensive multi-insurer system that is costing us billions in administrative costs or something that does a far better job of controlling costs and drastically reducing the red tape that is currently driving doctors out of the profession.

One way or the other, somebody is going to try to control costs. The current system, as Dr. Smucker knows from personal experience, isn't working. We can and should do a lot better.

Michael Dukakis



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