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Your Managed Care Editor, Ken Terry, asks, "Will primary care lead the way to universal coverage?" [March 19].
Most of the developed worldexcept, of course, the United Stateshas some form of universal health care. As an Irishman, I am not particularly fond of Winston Churchill, but I have to admit that he described the American approach to universal coverage perfectly. He said: "You can always depend on the Americans to do the right thingafter they have tried everything else."
Right now we are in the middle of trying everything else!
Joseph McEvoy, MD San Clemente, CA firstname.lastname@example.org
The American Academy of Family Physicians' socialistic solution to health care reform has given dimension to the misgivings I've had about the academy for the past 20 years.
In essence, these primary care providers want to mandate the conversion of new payroll taxes into "vouchers" that are redeemable through, naturally, primary care providers.
Many uninsured people elect not to pay vastly inflated insurance premiums. The source of that inflation: Medicare recipients and receivers of tax-deductible, employer-generated insurance benefitstwo sectors of the population that, in essence, are insulated from the cost of care. Their artificial demand drives up the price of care for the uninsured.
The solution to the high cost of health care is a 100 percent tax deduction for all health care expenses, including premiums, for every citizen. This deduction would be coupled with a medical savings account. Consumers would gravitate toward low-cost, high-deductible catastrophic insurance. Prices for more conventional care would plummet as buyers shop for value. Prices would drop further as third-party-generated overhead ceased to exist.
Stuart Andrews, MDBellingham, WAsra@qwest.net
I agree with most of your clear response to the Practice Management query about patients' paying bills with preauthorized checking ["Winning patients over to preauthorized checking," April 9]. However, I don't recommend a practice's covering the costs of bank fees, either directly or by giving a free 90-day trial. This has the effect of reducing the charges for the visit, and can present problems on audit, especially for Medicare and perhaps for other insurers.
In his response to a controversial new rule to eliminate mandatory physician supervision of nurse anesthetists [Practice Beat, March 19], American Society of Anesthesiologists President Neil Swissman said that "nurses are not doctors and should not be expected" to make split-second decisions that could jeopardize a patient's health. This arrogant statement shows a lack of understanding of advanced-practice nurses.
Nurses make split-second decisions on a daily basis and wouldn't intentionally jeopardize a patient. Rather than throwing stones at nurses, try to learn a bit about what they know. If you feel that more training is needed, offer itbut don't blindly strike out. You will find that advanced-practice nurses such as nurse anesthetists, nurse practitioners, and nurse midwives have a wealth of knowledge that can complement your experience.
No, nurses are not doctors. Most of us don't want to be.
Randa Sperling, RN
Midwest Internal Medicine, PC
Evansville, IN \
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Gail Weiss. Letters to the Editors. Medical Economics 2001;9:8.