• Insurance Speak
• Technology’s Role in Health Care Inflation
• Surgical Eye Expeditions
Reading “Refractive Lens Exchange Debate” (June) made me wonder if we are letting insurance companies dictate medical practice and terminology to us. (More than they already do.)
I do not perform refractive lens exchange; however, I take offense with the notion that a cataract has to meet “insurance vision levels” to be considered a cataract. I was taught that a cataract was any opacity in the natural crystalline lens.
A visually significant cataract is another matter. Depending on a person’s career or hobbies, a 20/25 or 20/30 cataract may seriously interfere with one’s lifestyle. Imagine trying to peel an epiretinal membrane or to grade a precious gemstone with less than perfect vision.
I am not suggesting that everyone over the age of 40 have their “cataract” removed, but as doctors we must remember that each patient is an individual and may be impacted in vastly different ways by the same level of visual impairment.
Geoffrey Brent, MD
Technology’s Role in Health Care Inflation
The problem that is bankrupting the health care system is also responsible for the greatest advances in health care: technology! We need to educate society on this concept so they can understand that—unless they willingly forego the advantages of technology—their health care contributions must go up.
A two-tiered standard of care will bail out those with means, as we saw when CMS decided last May to allow optional private payments for upgrading to multifocal IOLs. While a two-tiered system challenges one’s sense of fairness, it is still better than only one lowered standard of care, and the CMS decision is consistent with this. Perhaps the extension of such a two-tiered approach to other parts of our high-tech ophthalmic and general health care is a good idea, before 30 percent of physicians have to quit practicing due to cutbacks in reimbursements and rising costs of practice.
Blaming physicians for rising health care costs, while politically attractive at first glance, will not wash with the public in the long run. Those politicians who seek to balance the budget by driving physicians out of practice through cutbacks in reimbursements to untenable levels will surely make a name for themselves in the Archives for Hobgoblins of Little Minds.
I think the best approach is to educate the public. Physicians, physician organizations, lawyers, politicians, insurance companies and those in industry must teach the public about the acceleration that has taken and is taking place in the technology of health care and in every other niche in our society.
Yes, there must be efficiency, accountability and self-restraint in the entire health care industry, but we must not forget how little health care cost in 1900. Does the majority of society want to go back to 1900 standards of care? 1940? 1970? 1990? 2000? I bet not even 2006 when asked next year!
Only an educated society can make an educated decision. A responsible two-tiered approach could provide a viable compromise.
Peter George Gross, MD, PhD
Bryn Mawr, Pa.
Surgical Eye Expeditions
I recently returned from my fourth trip with Surgical Eye Expeditions International.
SEE is a nonprofit organization that employs small teams of qualified personnel recruited for short-term, sight-restoring clinics held on a recurring basis in medically underserved communities all over the world. In 2004, SEE physicians examined 175,000 patients and performed 13,000 surgeries.
Unfortunately, while the number of correctably blind people in the world is increasing, the number of ophthalmologists in the United States who are willing to help them is declining. These clinics don’t happen unless a U.S. affiliate signs up to go. And SEE is now finding it has to cancel some trips because of the lack of volunteers.
The majority of patients have bilateral mature cataracts and live in a world of total blindness. One woman in Romania told me after her surgery that I had given her back her life. This response is why I went to medical school in the first place.
I hope others will consider helping this worthwhile organization.
John A. Millin, MD
_____________________________Ed: For more information on SEE, visit www.seeintl.org.
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