My husband and I are baby boomers [Editor's Note, "Learning From the Best," August 2009]. While we recognize the need for some kind of healthcare for those who have none, what is being proposed to pay for it, along with the very real possibility that we may not be in charge of decisions regarding our healthcare, frightens us. We have healthcare provided to state retirees (Michigan) and pay a portion of the premium. We do not understand why the government is proposing an entirely new healthcare system when there are already two government sponsored programs in place (with administrators, field personnel to process, and eligibility criteria)—Medicaid and Medicare. Why can't this new program be tied into the Medicaid program? Those who do not qualify for the traditional/existing Medicaid program and qualify for this "new" program could participate through an arm of the Medicaid program created for uninsured citizens. The states would not bear the burden of any costs associated with the new program. We live in a border community with a sister city in Ontario, Canada. Their citizens come across the river to obtain healthcare because it can take months or even years to obtain a hip replacement or even cancer treatment. We do not want a system where we travel to a Third World country to have a hip or knee replaced—or heart surgery.
Patricia M. Shimmens, Sault Ste. Marie, MI
As the chief medical officer at Meritain Health, I have the unique opportunity to spend much time with America's workforce as I work to help employers truly understand their respective drivers of healthcare cost. What is of utmost importance is the poor health of Americans and the increased need for health services. This increase is what is driving cost along with technology, pharmaceuticals, etc. With improved health, the need for all these services, pharmaceuticals, and technology will be reduced. The proposed measures that I see will not improve quality or reduce cost. To reduce reimbursements to hospitals will force closure of some hospitals that communities desperately need. To reduce physician reimbursements at a time when 50 percent of primary care physicians are contemplating leaving the profession doesn't seem to address the problem. To adequately address the problem in a way that won't compromise the issues is to reduce the utilization of health resources. You do that not by rationing care but by focusing on improved health. Then factor in some degree of accountability. None of this is being proposed. I work with people now who have insurance, and they often don't use their prevention benefit until a health crisis occurs and of course then it is too late.
Larry Luter, M.D., Lutz, FL
There are no easy solutions to our healthcare problem. I would hope that we will preserve the system as it is for those who have good care and just concentrate on those who don't. Subsidizing the insurance costs of those who cannot afford to buy health insurance is undoubtedly something that will have to be done. That said, it would require significant co-pay so the system will not be overrun by those who go to the doctor for trivial illnesses. If a co-pay is not required, the system will self-implode from overuse. There are not enough doctors, hospitals, etc., to handle the demand if unrestricted access to healthcare is allowed. If the trivial use of the system is not controlled, rationing will inevitably result.
Jim Gaumer, Chico, CA
The onus on Medicare spending lies squarely in the hands of the providers. Since its inception, Medicare has been a cash cow for physicians and hospitals. To put the burden of Medicare costs on the elderly is unfair; like most of us, seniors erroneously put their trust in their doctors to do the right thing. Remember, Medicare isn't free. Healthcare costs incurred by Medicare recipients are a tremendous burden as evidenced by the fact that one in five seniors skip important doctor's appointments and medications because of these costs. The Kaiser Family Foundation reported that Medicare beneficiaries spent as much as 15.5 percent of their income on insurance premiums and healthcare services in 2003! If we truly want to reform healthcare we must weed out the doctors who are more interested in revenue streams from those who promised to help heal. A payment system based on value rather than fee for service would help accomplish this.
Jeff Kreisberg, Ph.D., Coppell, TX
Our country has been dragging its feet in caring for its citizens. This is a disgrace. Every other industrialized nation has single payer health coverage for its citizens. It is past time that Americans "grow up" (and this applies especially to the stubborn Congress members who resist every opportunity to do the right thing for the people). Insurance companies have a stranglehold on them because they are indebted for campaign contributions. I have followed this carefully and a large majority of Americans want single payer, as opposed to letting insurance companies continue to call the shots on people's health.
Bev Switzenberg Waters, Sacramento, CA
If President Obama wants to change the way the country gets its healthcare considering cost, effectiveness, and fairness, then he and all members of Congress should be participants in any plan that is adopted for the rest of us. What is good for us should be good enough for them. Then, and only then, will it be fair to all concerned.
Harold Monroe, Stockton, CA
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