I have just read several articles in Wednesday's Times that I find deeply disturbing. At the same time that Florida's immigrant population approaches 20 percent, with a 44 percent increase in immigrants nationwide since 1990, and 1.4-million more people nationally falling into poverty, the Bush administration is relaxing the rules that obligate hospital emergency rooms to provide care to the indigent (New rule will change emergency room care).
I have spent a lifetime working to help the poor and foreign-born gain access to health care. As a Florida health planner for Region 6, I chaired a committee that ran an innovative and award-winning program to provide primary health care to these populations. The care, concern and dedication of these committee members was not enough to save the program when federal funding cuts resulted in a loss of access to health care for more than 1,500 of Florida's rural poor (more than 60 percent of whom were employed). I completed research in one rural county that demonstrated economic limitations were the overwhelming obstacle to access to health care for this population.
Working on the U.S.-Mexico border with the Centers for Disease Control and Prevention and WHO-PAHO (World Health Organization-Pan American Health Organization), I documented the thousands of impoverished American citizens crossing the border to access medical care in Mexico, where it was available at low or no cost. We very seldom hear that story in the United States.
It is not EMTALA (1986's Emergency Medical Treatment and Labor Act) that "encouraged people to seek free care in emergency rooms," but the lack of a program to provide minimum standards of health care to every resident of our nation. For many hard-working, low-income residents of this country, EMTALA provides the only gateway they have to any kind of medical treatment.
The disparity between survival rates for minority and white cancer victims (Cancer deaths level off after years of decline), as well as other chronic illnesses is, at least in part, attributable to differential access to treatment. Programs to provide free screenings for cancer, diabetes, high blood pressure and other chronic conditions in low-income communities are laudable, but will never be effective in improving community health until funds are available for followup treatment.
Does the current policy "contribute to the overcrowding of emergency rooms"? You bet it does! Is treating these conditions in hospital emergency rooms an inefficient use of scarce resources? Absolutely! But until this country embraces a policy that secures the right to basic health care for every human being living within its borders, it provides the only safety net for our most vulnerable community members.
-- Lynette Benson Theisen, St. Petersburg
Use NASA funds here on earth
Re: New rule will change emergency room care.
By Jove! I think I've got it! I am referring to the badly needed solution to the ever-changing problem of emergency room care. Instead of putting this new rule into effect on Nov. 10, I propose that we stop throwing away - oops - I mean investing billions of dollars, into our broken-down space program at NASA. Instead, we can invest that money on living human beings, right here on earth. No one should ever be denied medical treatment and/or be turned away from any hospital emergency room. What ever happened to the Hippocratic oath? Each and every individual, no matter how little money he or she may have, deserves to get whatever treatment is necessary, in any given medical emergency.
It is totally obscene to waste billions in order to send astronauts into space conducting dysfunctional experiments and blow away wads on a money-sucking international space station. For crying out loud, we could use that money right here on earth to save lives. What is more important, the mystery of the unknown in outer space or saving and preserving the lives of our own people? Leave it to the mean spiritedness of the Bush administration to "relax the rules" of hospital emergency rooms. Just as long as their shenanigans don't affect any of their loved ones, they could not care less about the rest of us peons.
-- JoAnn Lee Frank, Clearwater
Compassionate conservativism
Re: New rule will change emergency room care.
According to George W. Bush, not only should they be out of work, destitute, homeless and uneducated, now the poor will also have to suffer through life-threatening emergencies with even more limited access to medical care. Laws dating back to the Reagan administration are being altered. Apparently it costs hospitals too much to treat people who don't have proof of insurance.
How many of us actually believe that the mega-corporation hospitals, with all the subsidies and tax breaks directed at HMOs and pharmaceuticals trickling down to them, are really so burdened with caring for a few poor people when they are charging the rich people thousands of dollars for a bed? Give me a break. CEOs and hospital administrators are not doctors - they are businesspeople. Hence, they never took an oath to "do no harm," and they are more interested in padding their personal profits than providing emergency care for people who may or not be able to afford it. Those poor, suffering, wealthy, greedy administrators! Maybe we should all just bleed to death on the street.
Boy, compassionate conservativism is great isn't it?
-- Nate Stafford, Tampa
U.S. needs a single-payer system
Financing of the U.S. health system is in very deep trouble and the only rational, viable solution to fixing it is a single-payer system. The United States spends $1.6-trillion per year on heath care. This is more than $5,000 for each man woman and child. We spend a greater percentage of our GNP on health care than any industrialized country in the world. And yet with these expenditures we have 40-million people uninsured and probably another 40-million underinsured. We have men, women and children dying and crippled because they do not have access to quality care. We have elderly citizens who cannot pay for prescription drugs. Managed care is failing in every aspect. It is simply administratively too costly and has produced excessive paperwork and time consumption. And it has produced a plethora of parasites feeding off the system without justifiable results.
With the savings from a single-payer system we can provide health care for everyone and prescription drugs for the elderly. This has been well documented in two recent studies published in the New England Journal of Medicine which demonstrate administrative costs of 31 percent in our current inefficient system.
There are several myths about a single-payer system that should be dispelled:
1. We cannot afford it. Fact, we are already paying for it.
2. This is "socialized medicine" (government run). Fact, the government would not run medicine. It simply would collect the taxes and pay the bills. Medicine would be run by the patients and their physicians. Patients can influence their care by their vote. They cannot influence the boards of the large for-profit insurance companies.
3. Medicine will be rationed. There will be long waiting lists. Fact, there are waiting lists in Canada and the United Kingdom for elective procedures, but these countries spend only a fraction of what we spend on health care. If they spent what we do, there would be no waiting lists.
Medical care is not a privilege. Every living human is entitled to good health and good medical care, not just the privileged few. The system cannot be fixed incrementally. A single-payer system is the only viable solution. The United States is the only industrialized nation that does not have such a system.
-- David A. Cimino, M.D., St. Petersburg
Interest in bedside manner is welcome
Re: Just what doctor ordered: a test for bedside manner, Aug. 31.
I am delighted to learn of renewed interest in the bedside manner and hope the skills are not shelved after the examination has been passed.
When I got my degree, medical science was rudimentary in contrast to today. We distinguished between the "art of medicine," and the science, leaning heavily on the former because of limitations of the latter. Gratuitous service was a hallmark of the profession. The hours were long and the doctors' families shared the stresses. The public responded with high esteem for physicians. I can explain, though not condone, the deterioration in the "art." The world has become largely depersonalized. Hospitals are far less dependent on charitable income and many are owned by profitmaking corporations. Ethnic communities and intimate neighbors of the past, held together by common needs, have disappeared. Families have separated geographically. Communication is now by digital means and telephone menus rather than live voice contacts. Bills are paid by third parties at fixed rates. Quantum advancements in medical science have led to longer life and improved quality of life.
Medical education has become more difficult, longer and more costly. It is never-ending, if one is to keep abreast of advances. Space, computer science, basic research and other intellectual pursuits are competing for the most talented students. The litigious medical malpractice environment, paperwork demands and practice controls are additional deterrents.
In this world, it is not surprising that doctors have also changed. I sincerely hope, however, that compassion and the invaluable "laying on of hands" will return to those practitioners who have forgotten them under the pressures of their daily work.
-- Seymour S. Bluestone, M.D. '43, retired, Clearwater
Experience teaches bedside manner
Re: Just what doctor ordered: a test for bedside manner.
Being the smartest student in your class doesn't make you the best doctor, neither does being the most compassionate person. What does is years of experience that no one can really teach you. I know doctors who are rude, arrogant and may not listen to everything a patient says, but they are excellent physicians, being able to diagnose and treat appropriately, efficiently and effectively.
Forcing med students to spend more than $1,000 to travel and face 10 "patients" with pretend diseases will in no way make them better physicians. As students they have the opportunity to interview and treat patients in the hospital, be mentored by community physicians to interact with their patients, and serve in clinics such as the Judeo-Christian Health Clinic to see real patients with real problems. It's what you call "on-the-job training."
Bedside manner is learned over years of experience, not during a 10-patient practical exam. And the last thing I want to do upon entering the exam room is to shake my patient's hand, only to learn upon further questioning that he or she might have an upper respiratory infection or diarrhea.
-- David Lubin, M.D., Tampa
When medicine is out of reach
How can anyone stomach what our government is doing - or rather not doing - about drug coverage?
The drug companies' defense is always that they need the proceeds from exorbitantly priced drugs to be able to do research on new drugs. Of course, one may presume they also need it to finance the avalanche of drug commercials - and to buy our legislators.
But if seniors and others cannot afford to buy these new drugs, what is the point?
This shabby treatment is a national disgrace. As long as politicians on both sides of the aisle line their pockets with drug money, there is no hope. "A pox on both your houses."
Does no one feel shame that the wealthiest county in the world has one of the worst health care systems among developed nations? I honestly don't know how they sleep at night.
-- Doris Whelan, St. Petersburg
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