Medicare/Medicaid architect sees vision realized in many ways, and other letters

Regarding coverage of the 50th anniversary of Medicare and Medicaid (Modern Healthcare, May 25, p. 13), in 1979 as an American Hospital Association/Blue Cross and Blue Shield Association fellow, I had the privilege of meeting Wilbur Cohen, the architect of Medicare and Medicaid, and the first secretary of the Department of Health, Education and Welfare under President Lyndon Johnson (predecessor agency to HHS). I was so impressed by his passion about expanding coverage to senior citizens and poor and disabled citizens of the U.S., who like all of us need healthcare and benefit from the security of health insurance.

Mr. Cohen's vision has been realized in many respects. Medicare and Medicaid have provided essential services to millions of Americans, have fueled the expansion of medical technology, expanded the capabilities of healthcare providers, and have resulted in greater life expectancy and extended quality of life for men and women in our country.

I am sure that Mr. Cohen did not fully anticipate the current size and complexity of Medicare and Medicaid, which now include an enormous CMS infrastructure, or how the healthcare industry would drive costs to 17% of GDP. Medicare and Medicaid have often been criticized for the lack of realistic financial planning and the impact on federal and state budgets, the unfunded costs of providing care in hospitals and physician offices—which has shifted those costs to employers and individuals in the commercial insurance market—and the regulatory burden that has significantly increased the administrative costs of healthcare.

However, the individual patient who now has access to high-quality healthcare never wants Medicare or Medicaid to go away.

Nancy Schlichting

CEOHenry Ford Health SystemDetroit

Regarding “As rural hospitals struggle, solutions sought to preserve healthcare access” (Modern Healthcare, May 18, p. 8), it was discouraging to read this article and note that not a single administrator mentioned the use of advanced practice registered nurses, such as nurse practitioners and nurse midwives, as at least a partial solution to filling the need in rural communities for primary care, wellness care, women's health and prenatal care and episodic/urgent care.

Research clearly demonstrates that these specially prepared nurses give as good—and sometimes better—primary and episodic care, and manage chronic, stable health problems, as other providers. Incentives will be needed to attract these graduate-level educated and nationally certified nurses, just as rural areas offer incentives to physicians to practice in rural areas. Also, state legislatures and insurance commissions will need to ensure that laws allow these nurses to be eligible for reimbursement by third-party and government-sponsored insurance plans.

Jean Farley, RN

Assistant professor, nursingGeorgetown UniversityWashington

I just read Modern Healthcare's Top 25 Women in Healthcare feature (Modern Healthcare, April 27, p. 14). Six of them are registered nurses. Why is that not noted? I know we nurses are not good at “tooting our own horns,” but our background and training give us a skill set that is unique to any other profession. Communication, collaboration, total human condition, providing care from birth to death and a host of other skills are learned, practiced and add to the life experience that is part of who registered nurses are.

As I told an 81-year-old friend who remarked that she “used to be a nurse,” I said, no, you are not practicing, but you will always be a nurse.

Geri Tierney, RN

Assistant professorPikes Peak Community CollegeColorado Springs, Colo.