Fee-for-service isn't to blame for healthcare's ills, and other letters

Regarding the June 30 editorial “Insuring against the future,” this article is another attempt to sell Americans on the notion that fee-for-service is the cause of our healthcare spending woes and must be abolished if we hope to get spending under control. As in other such articles, this assertion is justified by stating “system leaders are stuck with a reimbursement system that still rewards volume,” as if high volume of work and high quality cannot mutually exist. And going further to state that the “margins at hospitals performing one complicated surgery rose from $17,000 to $56,000 after things went wrong” blatantly suggests that surgeons might actually be deliberately causing complications so they could be paid more.

Fee-for-service incentivizes specialists to work as hard as necessary to keep up with fluctuating volume demands in their practices, keeps physicians accountable to patients, not bureaucrats, and encourages adherence to the ethical principles upon which medical practice is based—keeping what is best for patients the overriding basis for all medical decisionmaking.

Elimination of fee-for-service for specialists will create the exact situation we see in the VA health system: patients waiting inordinate amounts of time for care and the awful consequences that result for the patients and their families.

Dr. Thomas M. Flake Jr.

This was the right decision and has zero to do with women's rights, “Supreme Court backs Hobby Lobby; employers can deny contraceptive coverage.” It is about personal accountability and religious freedom. This ruling does not prevent women from having access to contraception and it does not allow Hobby Lobby to prevent their employees from using birth control. It simply says that Hobby Lobby and similar employers will not be required to pay for abortifacients. If having birth control and abortifacients paid for is the primary reason a woman works for a company or is so important that nothing else matters, then she is of course free to work for someone who strongly believes their job is to pay for all types of birth control or who simply isn't opposed to paying for it for religious reasons. Simply put, a woman's desire for free/covered abortifacients does not trump a private employer's right to object to providing them for religious reasons. Religious freedom, not freedom from religion, is what our country was founded on and remains a right we must protect.

Jackie Porter, R.N.

Regarding the recent article “Va. governor to bypass lawmakers, expand Medicaid,” here we go again. Force it down people's throats without regard to what the Legislature believes is appropriate for the state of Virginia. Another political move by someone who believes access without payment reform will solve the issues our industry is facing. Payment reform to the providers, especially the physicians, is what's necessary. Now you will see the committed providers run for the exits as they realize reimbursement does not cover costs.

Rich D'Amaro