NEW YORK TIMES: Universal Health Care, but by Whom?

Article Originally Appear Here in the New York Times

To the Editor:

Re “Universal Coverage Strains Massachusetts Care” (front page, April 5):

So hundreds of thousands of Massachusetts residents have been forced to buy health insurance only to find that there are long waiting lists to see doctors for basic primary and preventive care.

Dr. Patricia A. Sereno, one of the doctors you cite who are struggling to fit newly insured patients into their practices, unconsciously reveals the fallacy, the false hopes and the real interests underlying state and national health care reform efforts that would require that everybody hold a health insurance policy. “It’s great that people have access to health care,” she says, “but now we’ve got to find a way to give them access to preventive services.”

Insurance is not health care. What Massachusetts has done successfully is to provide a new revenue stream for the private insurance system. What remains elusive is health care for all.

Georganne Chapin
Tarrytown, N.Y., April 6, 2008

To the Editor:

In California, nearly eight million people live in officially designated primary care shortage areas. Millions more seriously ill patients must wait several weeks for appointments or seek care in emergency rooms, which drives up health care costs and leaves patients without essential follow-up care.

Family physicians in California support universal coverage and comprehensive health care reform that addresses the primary care doctor shortage. Ignoring this problem would derail any attempt to provide universal health care.

The lopsided payment system that richly rewards doctors who treat progressed illnesses but expects family physicians to subsidize the care that keeps America healthy must be changed.

In February 2008, yet another major study — this one by the Government Accountability Office — reported that primary care improves health outcomes and lowers health care costs. What are our elected leaders waiting for?

Carla Kakutani
Winters, Calif., April 7, 2008

The writer is president of the California Academy of Family Physicians.

To the Editor:

Thank you for bringing attention to the growing problem of access to primary care in Massachusetts. The problem has been worsened by our universal health care initiative, which was missing a strategy to increase the number of providers to serve the increase in patient load.

Your article, however, focused on increasing the number of doctors to solve the primary care shortage. Nurse practitioners have been filling this role for more than three decades by providing the best in health care.

We are the future of primary care. Make an appointment. We’re open.

Robb Stenson
West Falmouth, Mass., April 7, 2008

To the Editor:

When I received my recent acceptance package for Boston University’s School of Medicine for the fall 2008 class, included was information about costs for the current academic year at B.U.S.M.

Tuition: $42,734

Fees: $2,914

Room and board: $11,933

Books and supplies: $2,845

The tuition is expected to increase by at least 4.5 percent next year. Only about 30 percent of students at the school will receive any scholarship or grant aid from any source.

Many students can expect to graduate from medical school with debt of about a quarter-million dollars, not to mention any undergraduate debt that may remain.

With a debt load that size, a family practice doctor would probably take home less money than a registered nurse. Until the reimbursement system is fixed and the debt load addressed, there will be a shortage in primary care. The numbers don’t lie.

Lee Shapley
Philadelphia, April 7, 2008