Your Voice: Payer greed, not Obamacare, is the real healthcare woe

In response to “Healthcare reform must start with physicians, not politicians” (First Take, March 10, 2017), I completely agree that physicians should determine the best means for healthcare reform and delivery. Unfortunately, that boat has sailed years ago, and I’m not sure we can reverse it. 

Sadly, our profession has been hijacked by Wall Street and the government, oftentimes with corporate America’s influence over the government. They have even changed the language used in describing my profession. One used to go to his doctor to receive healthcare, but now he goes to his healthcare “provider.”

I am an internist, but most refer to that as a primary care physician. These linguistic phenomena, however, are the least of the medical field’s problems. 

We have certainly seen some changes with Obamacare recently coming into the picture. As a physician, the insurance companies’ manipulation of this has hurt me, but I still feel the changes it brought benefited the American public at large. I have been hurt by the system through the narrower networks offered by the insurance companies of which I as a physician have no control and thus some of my patients had no choice but to leave my practice as I was no longer in their network. 

We have seen some very angry people who blame Obamacare for all the ills of our healthcare system. They blame their rising premiums, large deductibles, and narrower networks directly on Obamacare. I, as both a physician and consumer, do not understand why hardly anyone ever talks about the massive elephant in the room as a large part of this problem. It’s not Obamacare, but simply put, insurance companies’ greed. 

Nowhere in Obamacare does it dictate that insurance companies must offer narrow networks, raise premiums and offer less coverage through huge deductibles. Moreover, I myself have kept my insurance and am not in Obamacare, but since the legislation, I have had to increase my deductible greatly to $5,000 to keep my monthly premiums under control. In addition, before President Obama was even a senator, my premiums increased every single year, which of course had nothing to do with Obamacare. I know I was not the only American facing this, but apparently, people have very short memories. Nevertheless, everyone, including the insurance companies, blame all these hardships on Obamacare and people believe this without question.

During the campaign, when these faults of Obamacare were greatly discussed, I was amazed no one raised the issue of insurance company greed. I even wrote to several reporters to see if they could write an article detailing the profits that are made in the insurance business by reporting on the major health insurance CEOs’  income including bonuses, stocks, and other perks. I think the public should be made aware of this aspect of their healthcare to both place blame where it truly belongs, but more importantly, to perhaps create a means to more avenues to solve our healthcare crises.

Louis Kanter, MD
Vernon Hills, Illinois

We must redefine primary care

In “Medical schools struggle to close primary care gap,” ( March 25, 2017) you mentioned that policymakers have been predicting a primary care doctor shortage for more than a decade.

Actually, it goes back even further than that. In 1966, The Millis Commission Report expressed concern that not enough primary care doctors were being trained.

Likewise, in 1994, the Institute of Medicine published a report that expressed the need for more primary care doctors.

Furthermore, in 1969, the American Board of Family Practice was formed to give primary care academic standing and respect alongside of the other 23 specialties that comprise the American Board of Medical Specialties.

Despite these efforts, a shortage exists. Primary care has been at the bottom of the medical hierarchy and it is likely to remain there. Some educators have expressed the need for more of these physicians but they are only a few and their voices are meek and barely heard. The critical mass needed to drive real change does not exist. 

Let’s face it, the culture of medicine has been specialty-oriented for about a hundred years. And it becomes more so every year.

Primary care is evolving into a diagnostic, referral and coordinating service. The primary care doctors of the future will be trained in community health centers in a customized curriculum that will be more practical and four or five years shorter than the current requirement of about 11 years. In addition, more nurse practitioners and physician assistants need to be added to the workforce.

What educators must do is redefine what primary care is and redefine how they should be trained. They have not done this. It may be that they are unaware of how primary care has changed, or reluctant to discuss openly what they believe in their hearts for fears of being ostracized by their colleagues.

Edward Volpintesta, MD
Bethel, Connecticut

Replace ACA with catastrophic coverage

Here is my idea for an Obamacare replacement plan: I would suggest a low cost, low deductible catastrophic insurance for everyone-that is administered through something like FEMA. Something akin to flood insurance required by mortgage companies. 

So many of us are so wildly independent and the young feel immortal. Thus, they feel no need for any type of insurance. 

Then a catastrophic event occurs and all of us pays for the uninsured. A catastrophic event could be leukemia, a major auto or motorcycle crash, neonatal catastrophe, prolonged ICU stays or events that drain bank accounts leading to malpractice proceedings in a desperate attempt to get something to live on. I’m guessing maybe $5 or $10 monthly perhaps paid through the IRS collection mechanisms already in place would probably cover it. Then, people can gamble as much as they wish with the rest of their healthcare.

Anne Trout, MD
State College, Pennsylvania