Readers And Tweeters Revisit Surgery Centers, Think Twice About Single-Payer

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

A Duty To Report On Surgery Centers

Your article regarding unreported bad outcomes from outpatient surgery centers (“Lax Oversight Leaves Surgery Center Regulators And Patients In The Dark,” Aug. 9) had been a concern of mine for some time. I am a retired radiologist and have personally seen bad outcomes and wondered if they are a public safety issue and go unreported. Accredited hospitals must keep track of outcomes, but the outpatient surgery centers are variable. Good investigative journalism as yours provides a valuable service to the public and will save lives.

— James LaManna, Gillette, Wyo.

On Twitter, a spine surgeon pointed out what he sees as holes in the story. Dr. Paul Kraemer, a specialist at North Meridian Surgery Center in Carmel, Ind., argued that the story was based on the false assumption that hospitals have better trained staff than do surgery centers. Rather than set up the dichotomy of surgery center vs. hospital, he told KHN, the article should have differentiated between generalist and specialty centers — that is, those performing spine procedures occasionally vs. every day. At specialty centers, the nurses in the recovery room can spot a problem — especially an airway problem — and alert a surgeon or anesthetist to intervene, he said. They see what is normal and recognize early warning signs of trouble, whether the procedure is simple or complex.

— Dr. Paul Kraemer, Carmel, Ind.

Dr. Ronald Hirsch of Illinois told KHN he has been trying for a year to get insight from the Centers for Medicare & Medicaid Services on its fast-track approval of increasingly complex procedures — while oversight lags.

— Dr. Ronald Hirsch, Elgin, Ill.

Glenn Krauss of Vermont explained why he avoids surgery centers at all costs.

— Glenn Krauss, Burlington, Vt.

Wanted: More Primary Care Physicians

We read with great interest the article “New Med School In Southern California Aims To Tackle Doctor Shortages” (July 27), reporting on efforts to increase the number of much-needed primary care physicians in traditionally under-resourced communities of color. Charles R. Drew University of Medicine and Science (CDU), in South Los Angeles, has been graduating physicians of color and other health professionals to work in underserved areas — mostly in California, but also nationally and internationally — for over five decades. Since 2000, over 70 percent of CDU graduates are from underrepresented backgrounds, and more than 80 percent report returning to practice in under-resourced communities following graduation. Our incoming College of Medicine Class of 2022 breaks down this way:

We applaud and welcome the efforts of another medical school in Southern California to help us in the challenge to address the chronic physician shortage in California.

— Dr. David M. Carlisle, president and CEO of Charles R. Drew University of Medicine and Science, and Dr. Deborah Prothrow-Stith, dean of CDU’s College of Medicine, Los Angeles

Jazmin Caton of Texas chimes in with a reminder about the need for doctors to train in underserved areas — not merely acquire an education there — to increase the likelihood they will stay around and practice.

— Jazmin Caton, Fort Worth, Texas

More is definitely better, tweeted an Ohio physician.

— Dr. Pradheep J. Shanker, Columbus, Ohio

Filling A Gnawing Need On Campus

“Insuring Your Health” columnist Michelle Andrews did her homework on solutions for a rampant problem: food insecurity among college students (“For Many College Students, Hunger Can ‘Make It Hard To Focus In Class,” July 31). Readers such as J.K. Devine of Gainesville, Ga., joined a chorus of those commending universities for coming to the aid of hungry scholars.

— J.K. Devine, Gainesville, Ga.

A Californian shared her firsthand experience with hunger as a college freshman.

— Paola Viveros, Oxnard, Calif.

Doctors for America, a coalition of 18,000 physicians and medical students whose goal is to improve access to health care, also rallies to fight hunger, especially among medical students who are at risk of being saddled with tuition debt.

Zachary LeClaire of California has adopted the philosophy that he would rather go hungry than let his college bills add up. On Twitter, he mused: Are parents doing enough to tend to the financial needs of their “dependents”?

https://twitter.com/GenYDiogenes/status/1024291653526335489

— Zachary LeClaire, Huntington Beach, Calif.

Although nutrition needs are being addressed where she lives in Washington state, Erin Davis looked at the big picture.

— Erin Davis, Spokane, Wash.

Second Thoughts On Single-Payer

In almost 100 percent of the discussions on health coverage plans, it is assumed that providers will both exist and will work for whatever the plan will pay them (“Once Its Greatest Foes, Some Doctors Are Now Embracing Single-Payer,” Aug. 10). Most people, when they hear “single-payer,” expect that everything will be covered with minimal copay and deductible. They are wrong, but no one will admit it upfront.

The alleged coverage crisis — wherein medical insurance was conflated with service availability, resulting in Obamacare — was caused by the government. Both Medicaid and Medicare health benefits were originally designed to provide basic health services while paying providers little more than direct costs, allowing private pay and commercial insurance payments to cover overhead and profit. Medicaid and Medicare were not expected to be a significant percentage of any provider’s practice. Over time, the good-hearted liberals kept expanding the scope of benefits with marginal improvements in reimbursement calculations and certainly without consideration of “unintended consequences,” especially the predictable ones pertaining to demand and cost.

Experience shows that A) any national single-payer system will be run at least as well as the VA and the Indian Health Services and B) our Fearless Leaders will exempt themselves from the system.

— Ed Connelly, Shaftsbury, Vt.

On Twitter, Ryan Quattro of Michigan wondered how an overhaul in health care policy might play against the backdrop of precarious foreign, defense and other domestic policies.

https://twitter.com/forzaquattro77/status/1024809880916508674

— Ryan Quattro, Ann Arbor, Mich.

A reader in Iowa warned that the flip side of single-payer means doctors would earn far less than they traditionally do, and that American innovation would be sacrificed.

https://twitter.com/SeanYolish/status/1027169188824211456

— Sean Yolish, West Des Moines, Iowa

Power to the younger generation, was the message from an Idaho tweeter.

— Tina Neidig, Boise, Idaho

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