David Burda's editorial on the uninsured ("Common sense on access," Jan. 26, p. 26) is a blatant affront to your readers. Apparently, he doesn't know or care that several national surveys have found that the uninsured have much higher rates of mortality and morbidity. Or that next to unemployment, lack of health insurance is the leading cause of family bankruptcies.
Or that the Emergency Medical Treatment and Active Labor Act, which guarantees uncompensated emergency care for more than 43.6 million people, has evolved into the nation's largest healthcare program and now threatens to collapse our emergency medical system safety net.
For a magazine that is otherwise dedicated to quality and ethics in the healing professions, these comments are supercilious and offensive.
Health Access Associates
... most uninsured are well-off ...
Of the 43.6 million uninsured Americans, I wonder what percentage are actually self-insured (Jan. 26, p. 26)? Also, I would be willing to bet that of the majority of the uninsured, many are not at or below the poverty line but own new vehicles, boats, a number of other motorized recreational toys and large-screen plasma TVs.
Putting aside a small minority who are indigent and eligible for assistance programs, it is often observed that health insurance is not considered a priority in many households until needed. If the uninsured aren't concerned, why should legislators be?
Our country was founded on democracy and not socialism or communism. Immigrants came here at the turn of the 20th century and before and made their own way without government subsidies. They were responsible and accountable for their own way of life and welfare. Who created the concept that it is our government's responsibility to find jobs and healthcare for the masses? Are we dealing with a different type of immigrant and a different type of American who, like a spoiled child, has been taught to demand and expect?
Director of reimbursement
... losing sleep over coverage ...
So David Burda might lose sleep over a football team's lineup but not the problems of the uninsured (Jan. 26, p. 26). His editorial was one of the most insensitive, offensive, politically biased articles I have ever read on the uninsured-and in a major healthcare periodical, no less.
I want to tell you, as an experienced healthcare professional who has recently joined the ranks of the self-employed and underinsured, I frequently lose sleep wondering how I will pay for my ambulatory care, preventive screening, prescription medications and all of the other services not covered by my current catastrophic coverage-the only coverage I could locate under a state-assigned individual health insurance plan once my COBRA coverage expired.
At least I have some coverage, which is more than 43.6 million other Americans can say. Shame on the deprecating attitude to the welfare of others expressed in your editorial. I expect more of a periodical directed at healthcare professionals who still believe that their primary mission is to help other people.
Marva West Tan
MW Tan Communications
... jobs are more important ...
Regarding your Jan. 26 cover story on access, "Sparring for control" (p. 4), why do our elected officials continue to treat the uninsured as an insurance issue, with the only debate being over who should pay-the government or the employer? It is not an insurance issue; it is, in fact, an economic issue.
In my community, the majority of the businesses are small, locally owned and operated, and struggling. As the nurse executive of a local medical center, and the spouse of one of those legitimate business owners whose customers do not want to pay higher prices, I understand why his company cannot provide health insurance and why my medical center struggles to cover the cost of care provided to the uninsured. Passing a law requiring employers to provide health insurance coverage will close many businesses, leaving employees not only uninsured but also unemployed.
If government officials pooled all of the expenses incurred in hospitals across the country for uncompensated care (a staggering dollar amount), it would provide the necessary supplemental funding for a national health insurance plan.
Chief nurse executive
Senior vice president of patient-care services
Wadley Regional Medical Center
... and hope remains for solutions
I read with great interest the commentary by Uwe Reinhardt on the outlook for solutions to the uninsured problem ("The promises and the reality," Jan. 26, p. 28).
Reinhardt makes a number of astute points about the challenges of tackling the tough problem of the uninsured, namely the significant costs associated with coverage expansion and various political hurdles. However, I am disheartened by-and disagree with-his pessimistic view of the possibilities of coverage expansions.
New York, like many states, has faced daunting fiscal challenges, but we have managed to make some progress on behalf of the uninsured-and hope to make more in this state legislative session.
Several years ago, the Greater New York Hospital Association teamed up with the 1199/SEIU union and a number of consumer and advocacy groups to develop and advocate for the passage of Family Health Plus, an insurance program for low-income uninsured families. Gov. George Pataki and the Legislature passed this bill in 1999, enacting the single largest expansion of health insurance coverage in New York since the passage of Medicare and Medicaid more than 35 years ago.
Today, hospital management and labor leaders have teamed up once again to continue to fight for the uninsured with a new proposal called the Healthcare Equity & Access Law for New Yorkers. HEAL New York would expand health insurance coverage, level the playing field between businesses that do and do not provide coverage, reduce health insurance costs for businesses that provide insurance, give fiscal relief to local taxpayers and improve the healthcare system ("GNYHA, SEIU to heal N.Y.," Jan. 19, p. 8).
Replicating ideas like Family Health Plus and HEAL New York on a national level would cover the vast majority of working uninsured families. Uwe, please don't give up hope!
Greater New York Hospital Association
Unbelievable. That's the only word to describe the letter to the editor by Craig Lambrecht in your Feb. 2 issue (p. 23) on the role played by James Cooper, the chief executive officer of Medcenter One Health Systems in Bismarck, N.D., on Medicare wage-index reclassification.
North Dakota healthcare providers, the state's congressional delegation and indeed Cooper himself know and have publicly acknowledged that Richard Tschider, the CEO of St. Alexius Medical Center in Bismarck, led the charge on this issue, having been the organizer of and participant in numerous trips to Washington to plead our cause.
At Medcenter One, in a private conversation attended by Rep. Earl Pomeroy (D-N.D.), Tschider and myself, Cooper thanked Tschider for his hard work on this issue, and he did the same at St. Alexius in a private conversation attended by Sen. Kent Conrad (D-N.D.), Tschider and myself. In fact, Cooper has been as vocal in his praise of Tschider's leadership efforts on this issue, as has Tschider in spreading the credit for the successful passage of this legislation.
It is sad that our success on this important issue is tainted by the biased comments of Lambrecht, which likely stem from his lack of knowledge regarding this important legislation and his lack of involvement in bringing it to reality.
Additionally, I am surprised that Modern Healthcare, which is dedicated to continuing discussion of healthcare policy and events, would waste the type in printing such a personally biased letter that has nothing to do with the objective of this important publication.
Chief executive officer
Mid Dakota Clinic
I could not believe it when a local administrator came into my office with the enclosed letter "Behind the index," which came from your Feb. 2 magazine (p. 23). I was totally shocked by its totally inaccurate and degrading content.
My staff and I spent many years working to receive relief from the unfairness of the reimbursement we were receiving from Medicare. If you need verification of this statement, please contact North Dakota's congressional delegation. Many times the chairman of our board and I made trips to Washington, D.C., to address this issue. When the legislation finally passed, the CEO of Medcenter One personally thanked me for my efforts, a fact that can be verified by others who were present when he did.
When I was called by your staff for input on the legislation, I mentioned that we helped put the language together for our congressional staff to attach to the prescription drug bill with reimbursement changes. Enclosed is documentation that will substantiate this fact. The call made to me was suggested to your staff by the North Dakota Healthcare Association, whose staff was aware of my efforts over the years relative to the Medicare reimbursement issues.
I cannot believe that a personal "attack" by someone such as this individual can be accepted as fact without verification or investigation by your people prior to publication. I have been in healthcare for 45 years and have never experienced anything like this. It is totally degrading and obviously challenges my personal integrity. This issue has totally distressed my family, my board of directors, my management and employees. What must my healthcare friends and associates around the country conclude after you gave this item national exposure with no corresponding comments from me?
President and chief executive officer
St. Alexius Medical Center
A large body of knowledge
Daniel Kane, in his Feb. 2 letter (p. 22) commenting on Michael Romano's cover story "Masters of the universe" (Jan. 19, p. 6) outlined his idea that healthcare administration is not a profession because administrators do not possess a unique core body of knowledge. I and the 19,000 other members of the Medical Group Management Association strongly disagree.
The ACMPE Guide to the Body of Knowledge for Medical Practice Management has been extensively researched and fully defined by the American College of Medical Practice Executives, the certification arm of the MGMA. This work details specific competencies, skills and knowledge that are unique to medical group practice administration and must be mastered for effective professional performance.
Managers in many other fields also would disagree with the claim that "there is no other field in which managers consider themselves to possess a unique body of knowledge that constitutes a profession." For example, the Project Management Institute has documented distinct competencies for its profession. Healthcare administrators must possess a unique blend of knowledge and skills, drawn from many basic management science disciplines, in order to be effective managers and leaders in healthcare organizations. For medical group practices, ACMPE has measured and codified that body of knowledge.
The American College of Healthcare Executives, the Healthcare Financial Management Association and the Health Information and Management Systems Society have similarly documented the body of knowledge in their respective realms of healthcare administration. All of our associations further the development of our profession through such efforts.
President and chief executive officer
Medical Group Management Association
American College of Medical Practice Executives
In your Jan. 12 News Makers column (p. 33) you mentioned that Hughston Sports Medicine Hospital in Columbus, Ga., has a new chief executive officer, Donald Avery. Though we do appreciate the article, is was written incorrectly. Though Avery did come from the Columbus Regional Healthcare System as a senior vice president, it doesn't own the Hughston Sports Medicine Hospital, as you write. HCA built the Hughston Sports Medicine Hospital 20 years ago and still owns it.
Coordinator of marketing and public relations
Hughston Sports Medicine Hospital