Down the Drain
I appreciated Peter Suderman's article about the federal government "flushing away" the $833 billion stimulus ("Down the Drain," May). It is an accurate portrayal of the way I see the stimulus from the front lines.
Elkhart, Indiana, was President Barack Obama's first non-Washington visit after he was elected president in 2008. We were the first community where Obama talked about the stimulus and how it would fix our unemployment. The first stimulus project for our community was the repaving of a runway.
The public might not see that as a worthy project because our airport has no commercial service. Few of our city residents will ever use that runway. It certainly didn't capture the imagination of the public. But I can't say it was a complete waste of money. It was a project that was planned, that needed to be done eventually. More importantly, five of our member companies received work from this project. I don't think any of these companies hired anybody for this project. However, it kept some workers employed.
I thought Suderman captured the situation well. From my vantage point, the stimulus wasn't a complete failure. It saved a few jobs, but it is hard to argue that it helped much. You exactly captured the problem about extending unemployment and what that does to the labor pool. We heard repeated stories from companies who could not hire people away from unemployment.
President/CEO, Greater Elkhart Chamber of Commerce
How Government Killed the Medical Profession
Dr. Jeffrey A. Singer ("How Government Killed the Medical Profession," May) is spot on with his recent article. His assessment of the degree to which the medical billing code systems contribute to cost escalation dovetails closely with a similar point made by Steven Brill in a recent issue of Time, where he described in detail the chargemasters used by hospitals to determine fees and how intimately associated they are with procedure and diagnostic codes. In addition, many of the evidence-based protocols drive this system as well, along with sets of "core measures" applied to an ever-expanding list of diseases and conditions.
My colleagues and I are constantly reminded of these metrics at our hospital staff meetings, with never any mention of how core measure compliance actually improves patient care. I have also noted completely superfluous extra interventions ordered or recommended for some of my patients, appearing only to increase reimbursement for that particular Medicare code. God forbid that we should object to any of these measures, lest we be labeled "disruptive physicians" and referred to physician health organizations or, worse, to the state board of medical examiners.
Lamentably, we as physicians have enabled this sequence of events, mainly through reliance on professional organizations that we had entrusted to look out for our best interests while they were actually working in concert with regulatory entities. It is high time that we come together to preserve the practice of medicine and reduce third-party intrusions.
Nicholas A. Tsambassis, M.D.
I want to thank Jeffrey Singer for his article. I spent 41 years as a teacher. Put the word "teaching" in the title, and "teacher" for "doctor" and "student" for "patient" throughout the article, and Singer has accurately described the demise of education as well as of his own profession.
The description later of the proliferation of "fee-maximizing advisers and seminars" fits education. In our case most are subsidized with tax dollars. Education also has its "evidence based, cookie cutter" mandates. They're known as "standards and benchmarks, state mandated core curriculum, standardized testing." Teachers also face hours of adapting to computer-based record keeping and tracking "data" that we suspect is mostly used by no one. Decisions about what it means to be educated are made by those as far away from the individual student as possible. It's madness.
I worry that the new generation of teachers are nothing more than assembly-line workers plodding through state and federal mandates. I worry that my grandchildren will be treated to a mediocre government education—and unless they have the cash, a mediocre health care system as well.
Rockwell City, IA
I found Jeffrey Singer's piece, "How Government Killed the Medical Profession," to be an enlightening, perceptive, and important article on how government interference is destroying medical care.
I retired at age 52, and from that age until I turned 65 I carried no medical insurance. Luckily, I've been in relatively good health, but when I did need medical care, I paid cash, made it clear to the various doctors I visited that I intended to pay cash, and frequently was able to negotiate fairly good prices for the services I needed. The best part was that I felt in total control of my own care—with input from physicians, I decided on what care and procedures I wanted or didn't want. I took great pleasure in taking full responsibility for my own health care.
Last year, at age 65, I got my Medicare card. Recently I decided to exercise that card for the first time. I checked into the emergency room of a local hospital. What followed was 24 hours of the most impersonal, overbearing treatment I've ever been subjected to. They checked me into the hospital; they would not let me go home in the evening, maintaining that they were "required" to keep me overnight and monitor me continuously. They administered pills and injections without explaining what the drugs were or what their purposes were. They ran a number of expensive tests without asking me for permission or approval, and certainly without talking about their cost. My big shock came when the final bill arrived. The total for everything was over $20,000. That was shocking enough. But what really opened my eyes was the amount I was expected to pay: $16. My first reaction was to write a note to a close friend and say, "Man, is this system broken." I hope many people read Singer's article.
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