The Baltimore Sun

Medicare must control wasteful spending

As a primary care physician who cares for elderly patients, I read the editorial "Health care reform" (Dec. 26) with interest.

The editorial correctly pointed to the obscene discrepancy between the salaries of primary care doctors and specialists as part of the problem in providing cost-effective medical care. But the real question is why specialists earn so much and use up such a disproportionate percentage of our health care resources.

Medicare could easily fix the problem by altering its reimbursement policies and limiting visits to specialists, and leaders of Medicare have been talking about doing just that for 20 years. But they have done nothing. Why?

The answer is simple. The people of this country, prompted by the media and politicians, erroneously believe that more testing is better than less, that specialists provide better care than "general" doctors, that being in a hospital leads to better care than being at home and that any restriction on access to tests and doctors is akin to socialized medicine and leads to bad outcomes.

Our very medical ethos has led us into this mess, and our politicians do not have the political courage to curb spending on patients.

As someone who works within the Medicare system, I see patients and family members demanding services that cost thousands of dollars because they can do so without any restriction or cost to themselves. Some of these patients are very old, demented and terminal. The tests and treatments are usually excessive.

But in a Medicare system in which the patient can get nearly everything he or she wants for practically no cost, and in a country that believes more is better, this cycle of spending knows no end.

Unless we can change the nature of our medical culture and restrict our excesses, not only is a universal health care system doomed but the systems we have now will collapse under the weight of our insatiable appetites.

Dr. Andy Lazris, Columbia

Time to reorganize the delivery of care

Dr. Thomas F. Lansdale III's comments on retainer-model medical practice underscore the complete failure of the free market to deliver quality medical care at a reasonable cost ("In defense of so-called concierge medicine," Dec. 29).

The market inefficiency of allocating physicians to high-income specialties at the expense of more important primary care, the Kabuki dance between insurers' attempts to reduce costs and physicians' attempts to maintain income, and the increased caseloads necessary for doctors to cover their ever-increasing costs have led to assembly-line medicine.

Those seeking medical care have become profit centers rather than patients, just like customers in any other business.

Until the delivery of medical care is rethought and properly organized, not just tweaked around the edges to avoid admitting the failure of the free market, the situation will only get worse.

Thomas G. Pinter, Lutherville

'Concierge' model offers a free-market solution

The Maryland insurance commissioner's idea that the state might regulate "concierge" medical practices threatens to cause a gross violation of individual rights ("Md. ponders regulation of 'concierge' medicine," Dec. 20).

Patients and physicians have the absolute right to voluntarily contract for medical services in a free market.

Under the concierge medicine model, physicians can spend more time with their patients and practice according to their best medical conscience, for reasonable reimbursement. Patients receive improved quality care for a fair price. It is truly a "win-win" situation.

Instead of further government controls over medicine (such as "universal health care") that harm physicians and patients alike, America needs more such free-market reforms.

Otherwise, we'll all pay the price.

Dr. Paul Hsieh, Sedalia, Colo.

The writer is co-founder of Freedom and Individual Rights in Medicine.

Obama's pastors belie liberal image

What is it with President-elect Barack Obama? For 20 years he aligned himself with an anti-Semitic preacher (the Rev. Jeremiah A. Wright Jr.) and now he chooses Pastor Rick Warren, an overtly anti-gay preacher, to deliver the inaugural benediction, alienating a large portion of the population.

Who says Mr. Obama is a liberal?

Geraldine Segal, Randallstown

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