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I respect internist James Mooney for turning down his financial adviser's recommendation to invest in Philip Morris stock because of his concern about diseases linked to smoking ["My best quit-smoking aid: Philip Morris," Feb. 22].
However, following his principle of responsible investing, Mooney should rethink his purchase of the stock he bought insteadCoca-Cola. I'm sure he also treats conditions linked to the consumption of empty, nutritionless calories. Obesity and adult-onset diabetes readily come to mind.
The financial distinction between for-profit and nonprofit HMOs is largely artificial ["HMO quality: Does for-profit status matter?" Jan. 25]. There are fewer differences between them than one would think.
For instance, nonprofit plans, which are tax-exempt, actually have more of an incentive to make a profit than for-profits: every dollar they make, they keep. Also, they have no tax-loss cushion, so if they lose money, they lose it dollar for dollar. Being profitable is also an advantage when nonprofits must raise capital in the bond market. The attractiveness of a steady stream of rising profits allows them to sell their bonds at lower interest rates.
Financially speaking, what determines the quality of an HMO plan is its profitability and net worth, not whether it is labeled for-profit or nonprofit.
I see flawed logic in Franz Ritucci's assertion that emergency care can be delivered more cost effectively at ambulatory care centers than at hospital EDs ["Letters to the Editors," Jan. 25].
Certainly, a patient at an ambulatory care center may receive a smaller bill. But the absolute cost of delivering care is the same. It's just that the health care delivery system is squeezed to provide service at a lower price.
Ambulatory care centers are the health care equivalents of fast food restaurants. They often hire staff with minimal training. To stay profitable they must shuffle patients through at less than five minutes per encounter.
In this region, ambulatory care centers are a broken model. Faced with high overhead and low reimbursements, physician-operators are closing their doors and going back to work in hospital EDs.
Tony A. White, MD Albertville, AL
What do you call a place where emergency medicine is practiced? It's the ED, insists Dennis Whitehead, whose letter prompted you to change your editorial style from ER to ED. Although for years I've been part of the movement to inculcate the term ED or emergency department into the lexicon of our hospitals, publications and profession, I now have mixed feelings about that.
For one thing, unlike Whitehead, I believe the television show ER has elevated, not demeaned, our profession in the eyes of the public. Moreover, now that the term ED has taken on the meaning of erectile dysfunction, it makes me question whether I want to be thought of as an ED physician. Right now, I'm proud to be an ER doc.
Charles A. Pilcher, MD
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Letters to the Editors.