Your Voice: “Curing an American Sickness” great idea, but more is required

Your article on “Curing an American Sickness” (August 10, 2017) addresses many of the important issues that confront us as we try to control soaring healthcare costs and provide care for millions of uninsured or under-insured Americans. 

Ms. Rosenthal’s comment about hospitals looking like “Hiltons” and patient comments about “the art and coffee” highlight how we often rate healthcare facilities. This is one of the outcomes that occur when medical care becomes as much a business as a healthcare endeavor.

One issue that was not addressed is the unrealistic expectations about the healthcare delivery system. As Richard Lamm pointed out years ago in his book, “The Brave New World of Health Care,” we have a system that is the most expensive one in the world and yet our outcomes lag behind those of many other first world countries. 

We have created a system where people confuse intensity and rapidity of care with quality of care. This increases the cost of care and at times will actually lead to more complications. Realizing that no solution is perfect, we need to develop systems that provide high quality, timely intervention and control cost.

Another issue that often goes unstated is the cost of uninsured or under-insured care. In this country, you will receive care whenever you come to a facility needing immediate care. If you cannot pay for it, then that cost is factored into the costs for insurance, hospital care, etc., for everyone else. In addition, the inability to get preventive care for those same people leads to more advanced disease or preventable disease, which again increases healthcare costs. We need to have a system that covers everyone. This does require some additional cost up front, but avoids much higher costs later.

In addition to addressing the issues raised in the article, we must include these unrealistic expectations and insurance issues if we ever hope to control costs.

I applaud you for raising the issue and hope the medical community will come together and try to finally develop a comprehensive solution to this problem in partnership with all the other players.

Larry Ballonoff, MD
Denver, Colorado

Government making me want to quit medicine

All the government fiddling-the latest being MACRA and MIPS-will be the death of rural, solo and small practices. I have managed to make the leaps and bounds with all the various programs in my solo practice until now. But I don’t think it is tenable to force my staff to keep learning more rules and be even more involved in data collection for the government.  

The staff has become stretched beyond their abilities and capabilities. This is the first year I seriously contemplated giving up a very much needed and very busy rural family practice-to let my staff and me “off the hook” if nothing else. There has to be a better way to practice medicine in America. This is definitely not the way. 

Sigrid Johnson, MD
Sweetwater, Tennessee