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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.

1. No mention of millions who have had surgery safely to provide perspective.

2. No mention that same complication can happen in hospital (seen it)

3. No mention of conflicts inherent in hospital news promoting and funding story

4. No mention of steps taken to prevent tragedy

— Paul Kraemer MD (@PK_Spine) August 1, 2018

— 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.

And yet, @CMSGov allows @Humana to authorize "Inpatient Only" surgeries to be done at surgery centers on Medicare Advantage beneficiaries. Hip fracture repair? Open cholecystectomy? Carotid artery stenting?

— Ronald Hirsch, MD (@signaturedoc) August 10, 2018

— 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:

  • African-American — 50%
  • Hispanic-American — 43%
  • Asian-American — 7%

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.

If the goal is to keep new physicians in the area, residency training has to be a part of the plan. New Medical School in Southern California to Tackle Doctor Shortages | Healthiest Communities | US News #highereducation #medschool

— Jazmin Caton (@jazzycaton) August 1, 2018

— Jazmin Caton, Fort Worth, Texas

More is definitely better, tweeted an Ohio physician.

We need a lot more med schools, and med students.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 15, 2018

— 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.

Enjoyed reading your story about college students going hungry. The University of North Georgia is one of those universities that has started food pantries on 3 of its 5 campuses to help students, faculty and staff who need it.

— J.K. Devine (@JKDevine1) July 31, 2018

— J.K. Devine, Gainesville, Ga.

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

I remember freshmen year going to bed hungry every night, wishing I was home so I could at least have cereal. I did have a dinning hall pass, but social anxiety and peak dinner times don’t mix.

— Korahline (@Krhddg) August 1, 2018

— 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.

While the US is the wealthiest country, up to a half of all college students suffer from food insecurity. We must not allow future medical students to suffer from such a gap. All while the US is declining their contribution to student financial aid

— Doctors for America (@Drsforamerica) August 3, 2018

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”?

One of the main problems with this is many college students are under the age of 24 and are considered "dependent students" regardless of whether or not they're parents actually give them any money. Also I'd rather eat 1 meal a day than be in debt for the rest of my life

— The Useless Philosopher (@GenYDiogenes) July 31, 2018

— Zachary LeClaire, Huntington Beach, Calif.

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

Proud and thankful that my institution has a food bank for students. Food insecurity among community college students is a pervasive problem that also needs larger, systemic solutions.

— Erin Davis (@FreckleErin) August 1, 2018

— 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.

We need to have a conversation on what single-payer means for US role in the world.

End of role in NATO and seriously reduced military means reduced influence in world. Then there is the issue of infrastructure. $2.5 trillion. America is a hot mess.

— Ryan Quattro (@forzaquattro77) August 2, 2018

— 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.

Wait until these new physicians have to pay back their student loans on single payer compensation…good luck…oh, say goodbye to innovation, too. #ShameOnce Its Greatest Foes, Doctors Are Embracing Single-Payer via @khnews

— Sean Yolish (@SeanYolish) August 8, 2018

— Sean Yolish, West Des Moines, Iowa

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

The youngin's are gonna change our country for the better. I believe that. Enough is enough.

— IndiraShanti (@IndiraShanti) August 2, 2018

— Tina Neidig, Boise, Idaho

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