Opinion | When companies take over healthcare

To the editor:

About “Insurers Add Primary Care to Portfolio” (front page, May 9):

The fact that “multi-billion dollar corporations, especially giant health insurers,” are eating away at primary care practices in order to make more profits and gain more control over health care delivery is something that most American doctors seems to me to be old news for As the power of corporations in our healthcare system grows, so does the power of doctors.

Being a primary care doctor in America was great in an era when doctors, not corporations, were leading the way.

Calvin Shaps
Los Angeles
The author is a physician.

To the editor:

In 1980, Dr. Arnold Lermann, editor of the New England Journal of Medicine, considered the rise of the “new medical-industrial complex” to be “the most important medical development of the time.”

America’s vast empire is now cementing that empire with the addition of primary care, crushing the autonomy left for the medical profession. No profit-seeking organization should be given this overwhelming power to control healthcare. It is precisely the conflict of interest of interest motive rather than impartial patient care.

Moreover, as the private sector buys up health care facilities such as nursing homes, costs continue to rise and quality declines.

We need to promote health equity, not private equity. When Americans realize that their tax dollars are being used to subsidize American corporations, maybe we can see the light. As history shows, empires rise and fall. We need to save America’s health care before it gets any worse.

Sheryl L. Kunis
new york
The author is a nephrologist and bioethicist, emeritus professor of clinical medicine at Columbia University, and director of national affairs for the New York Chapter of Physicians for the National Health Program.

To the editor:

“Insurers Add Primary Care to Portfolio” outlines many of the risks posed by the fast-moving trend of physicians becoming employees of large commercial organizations.

Serious ethical dilemmas, unnecessary care, and safety complications can arise when physicians base their medical decisions on the achievement of benefit expectations. For some doctors, employment in a non-profit environment may feel safer.

But in both situations, strong physician leadership is a key solution, experts agree, playing a key role in building a mission-driven culture and de-risking patient care. . Hospitals and private equity firms that own doctor’s offices need to find ways to give doctors a say in deciding how to operate their offices.

In doing so, the downsides of integration can be offset by strengthening the close patient-physician relationship, and the moral strain that can arise when financial and patient care considerations are out of balance. You can protect the well-being of doctors. Training physicians to take on a supervisory role while communicating with patients is also critical to maintaining people’s health, which is the most important goal of healthcare.

Alexa B. Kimball
The author is Harvard Medical School Physician Chairman and Chief Executive Officer of Beth Israel Deaconess Medical Center and Professor of Dermatology at Harvard Medical School.

To the editor:

Why would giant corporations buy primary care practices, and why would investors buy their shares? Because they expect to make a lot of money. The question is how do you make enough money to make these a good investment?

When a patient’s care is paid for at a fixed price (that’s what HMOs thought in the 1970s), the only way to make money is to spend less on care. Here’s how to do that: These include registering healthy people who do not need care, providing less care to those who need care, and paying less to health care providers.

An alternative is a pay-as-you-go plan. In that system, the more services you provide, the more fees you earn. When primary care providers are integrated with other levels of care, organizations not only have incentives, they have the means to do so.

Talk of delivering better care more efficiently is nothing more than a public relations stunt to appease the public—and regulators. — approve these purchases.

As students studying the health care system have long pointed out, the market-oriented U.S. system spends astronomically more than other developed nations, and the results are even worse. Markets may be great in other areas, but when do we stop believing they are the best way to deliver these essential services?

Stephen M. Davidson
The author is Emeritus Professor of Health Sector Management and Policy at Boston University.

To the editor:

About “Baby Boomers Leaving Riches, Still Mostly for the Rich” (May 15 front page):

I read with interest this article about the largest wealth transfer in history where trillions of dollars have increased inequality. I have no objection to the extraordinary and unprecedented wealth that comes into new hands, but my experience working with millennials and Gen Z heirs gives me hope.

Their mindsets, values, and responsibilities include broad and comprehensive standards for how they use their resources to drive social change.

The young philanthropists I work with are unwilling to accept the status quo. They feel it is their responsibility to know deeply about the systems they are trying to change, including the systems that have enriched them and impoverished others. They act with curiosity and humility, not ego or greed.

Paradigm shifts and new breeds of philanthropists are needed to solve major global challenges such as gender inequality, climate change and food insecurity. I hope this next generation of wealthy people will lead to the greatest philanthropic generation the world has ever seen.

Lena Greifinger
The author is managing director of the Maverick Collective, a community of women philanthropists.

To the editor:

“Joy, Loneliness and ‘Rejuvenation’: Becoming a Mother After 40” (Family, nytimes.com, May 14):

As a child with parents in their 40s, I read the article with interest. I am the youngest of six children, born in a “late-life surprise” when some of my siblings were old enough to be parents.

My mother, like most married women in those days, was a stay-at-home mom and did not work outside the home. I grew up surrounded by adults and she became her aunt at age five. I remember always being aware that I was the child of older parents. Of course, there were reminders, such as when I was young and when I walked in the front door and the person asked to speak to her “grandparents.”

I had noticed that most of my classmates had different family structures and had brothers and sisters of the same age. In some ways, I felt like an only child, but I had a summer trip to visit my brother and sister who lived a short distance out of the state.

My father retired when I was in high school. As a teenager, I got a front row seat to what retirement meant.

Late children with older siblings can also be subject to a special kind of jealousy and resentment. The last child, born much later than the other children, is often considered “spoiled,” receiving more generosity, consideration, and material things than the older children. Later children also comfort their aging parents in their later years.

One drawback, of course, is that, inevitably, only children born later in life may be left behind.

Rebecca S. Farlander
Bellevue, Nebraska.
The author is a former Adjunct Professor of Psychology and Sociology.

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