Priced out of the insurance market and other letters

Regarding “Low enrollment expected to amp up pressure to tinker with ACA” (ModernHealthcare.com, Nov. 13), healthcare is now affordable for those who are going to get it free. However, it is now too expensive for those who used to have it to afford it. I have been personally priced out of the market. My healthcare insurance should not cost more than my house or car payment.

Teresa Marshal

Hope Family MedicineOrting, Wash.

The Nov. 11 cover story (“What doctor shortage?” p. 14) discussed physician shortages more in the context of primary-care shortages. It is clear that given the present patient-care demand, there are not enough graduating physicians, advanced-nurse practitioners, pharmacists or physician assistants to provide adequate and timely primary care. Real disruptive innovation in the process such as telemedicine, retail clinics and group appointments might alleviate these shortages.

The major issues we anticipate involve shortages of surgical specialists. The Association of American Medical Colleges projects a shortage of 46,000 “non-primary-care” specialists by 2020. My colleagues and I previously calculated that the U.S will have a shortage of more than 29,000 surgeons in seven common surgical specialties by 2030 (Williams, Satiani, Thomas, Ellison; Annals of Surgery, 2009).

A recent paper by Dall and colleagues in the journal Health Affairs also indicates that it is specialty docs who will be in short supply, including vascular surgery, neurologic surgery and general surgery. My specialty, vascular surgery, is expected to be the hardest hit, with a 31% projected increase in demand by 2025. This is primarily because of our aging population. It does not seem likely that we will be able to train nurse practitioners, pharmacists and physician assistants to do specialty surgery by 2025.

Dr. Bhagwan Satiani

Professor of clinical surgeryOhio State University College of Medicine, Columbus

I found Modern Healthcare's initial online headline to be very misleading: “HealthCare.gov sees fewer than 27,000 signups since Oct. 1” (ModernHealthcare.com, Nov. 13).

The headline suggested that no one is signing up for the new plans. The article then went on to say: “Nationally, just over 106,000 individuals signed up for coverage through the exchanges. California had the highest number of enrollments, with just over 35,000.”

You then mention: “Enrollment in public programs is proceeding much more briskly. Nearly 400,000 individuals were determined to be eligible for either Medicaid or the Children's Health Insurance Program during the first six weeks of enrollment.”

Lots of people nationwide are utilizing the newly available plans to obtain health insurance coverage. So why not present it that way in the first place? I fail to understand why there is so much subterfuge and misinformation associated with everything surrounding this law.

Kelli J. Nicholas

Cardiovascular ConsultantsLos Angeles

Regarding the Vital Signs blog post “Group representing physician-owned hospitals targets ACA restrictions” (ModernHealthcare.com, Nov. 12), the Affordable Care Act is carrying over the current moratorium on physician-owned hospitals. It is nothing more than a lobby-driven initiative by those who want to restrict the growth of healthcare venues with a true passive-aggressive approach that will limit competition—promulgating a misleading claim that physician-owned services drive up costs when the opposite has proven to be true.

Conrad Vernon

Heart & Vascular ConsultantsBurnet, Texas

The Nov. 4 editorial (“When keeping what you have means ignoring those who don't,” p. 26) asserts that the Affordable Care Act is the answer to the question, “Am I my brother's keeper?” and implies that anyone who does not support the ACA is some sort of modern-day Cain. I respectfully disagree and resent the implication. I do not dispute the failings of the prior system, but it was naive at best to think that completely scrapping it would be a good idea.

If the goal is to reduce the cost of healthcare while maintaining or improving quality, and to ensure that everyone has access to care and the means to pay for it, the ACA is a poor solution. If you find termites in one corner of your house, you don't tear down the whole structure, you fix the problem.

If we really want to resolve the cost of healthcare, government must work on jobs and the economy to improve everyone's financial situation. Second, we in the healthcare industry need to double down on efforts to control the things that drive costs up. Medical errors, other waste and duplication, and standardized (electronic) recordkeeping are some of the areas where impacts can still be made.

Raymond Peter Zambuto

President,Clinical Engineering ConceptsAshland, Mass.