Your Voice: Obamacare's failure caused by a miserable compromise

In your September 25, 2016 issue, you blast the failure of Obamacare and ask for solutions for the uninsured.

While being called a failure, data shows some 30 million newly insured now receiving care due to Obamacare. Further data is showing that in states that have implemented it are now showing improvements in health compared to states that have not.  

The “failure” cited is due to the increased bureaucracy, and inability for the insurance companies to capitalize on their opportunities, and why they are sequentially bailing out.  Thereby the ‘failure” of Plan B, aka Obamacare. Nobody is making money.

Does anyone recall the original Plan A?  It was Obama and Ted Kennedy proposing universal healthcare, like in most other civilized countries.  But at that time there were vocal opponents among our leadership that had no problem announcing their full opposition and to obstruct ANY goals the president was seeking.  Plan A became Plan B in the compromises.  

Those vocal opponents surmised universal coverage would require a single payer, the government.  The howling proceeded, stating that it would not be fair to the insurance companies and would portend their demise.

So, the failure of a miserable compromise in health care is blamed on Plan B. A significant population still is uninsured.  The results of even Plan B have shown the improvement in health in those now covered.  A plan that would include everyone would certainly have an even bigger effect and improvement on the population’s health.  I can say this based on 20 years in community health and seeing the improvements from Plan B, simply based on availability of care.  

The remaining uninsured are likely the most desperate and sick and likely need the most care.  Funny though, among my uninsured patients, they complain the least.  The cost to cover them will be an even tougher pill to swallow.  Yet it will improve the health of the general population.  It is a no-brainer these people need our help and in implementing care, it will improve our overall health.  

Now, if we could get the opportunists out of the picture and their profit motivated paws out of the cash flow we’d have a better chance.  It’s clear medicine has become big business.  

As a great physician noted, “when medicine becomes a business, we have lost our moral compass.”

Back to Plan A.

Jonas Navickas, DO

Punalu’u, Hawaii

Doctors need to do more to combat over-reliance on opioid prescriptions

As an internist who practices primarily pain medicine, I am sympathetic with Dr. Rodney Staats’ critique (Your Voice, September 10, 2016) of the recent CDC guidelines. 

Patients are suffering as a result of the backlash against addiction.  Sometimes it seems like some physicians in leadership roles have a puritanical attitude towards opioids and one senses that if the roles were reversed, and they-or their wife or father-were the patient, they would be arguing in favor of their use.  

The CDC did a very careful job of reviewing the (scant) evidence and wound up recommending (sensibly, I think) avoiding opioids for chronic pain. But, then went on to discuss prudent steps to minimize excessive reliance on them and providing some common sense precautions.  No big deal, in effect.  

But, the message the CDC wanted to send seems to have hit the mark. 

Inevitably, we will continue writing for long-term opioids for those who benefit from them, and I very much doubt there will ever be a clinical trial that resolves the question of chronic efficacy. How are you going to find people suffering from chronic opioid-scale pain who would consent to be randomized between NSAIDS and opioids for a year? Two years? Five years? 

I have many patients who have done well for over a decade on modest opioid doses, without escalation, and without serious side effects.  These are the people that primary care doctors need to advocate for. 

Since before Hippocrates, the poppy has been the one most reliable answer the physician had to the challenge of human agony. If we won’t step up to this plate, then I’ll give you three guesses who will.

Donald Dillinger, MD

Everett, Washington

Concern over nurse practitioners not valid

I sympathize with Dr. Savoretti’s position on the burdensome MOC process (“Eliminate MOC’s cumbersome process and physicians will get on board,” March 25, 2016).

However, his concern about nurse practitioners practicing primary care warrants an afterthought.

The work of the primary care doctor has become too difficult for most. Burnout is widespread among them and many are going to a part-time schedule. Others have quit or joined large hospital networks or taken on administrative positions in healthcare.

The point is that as long as they practice within the limits of their training and education, nurse practitioners will provide as they already are in some states, a valuable and much-needed addition to the primary care workforce.

Nurse practitioners are licensed to practice independently in over 20 states.

Edward Volpintesta, MD

Bethel, Connecticut