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Medicare Collapsing 

Dr. Richard P. Mills’ message in “When Does Reality Set In? When It Happens to You” (Opinion, November/December) is clear: Private health care companies are abusive to many individuals, and Medicare and other potential government plans are much better for patients and MDs. After all, they allegedly have a minimal administration expense of 2 percent, and Dr. Mills’ billing staff reports that Medicare does not question bills for his services as often as the private companies do.

Medicare’s 2 percent administrative fee is a total hoax. Private insurance companies must have a fund of billions of dollars available to pay future costs or they cannot exist. Medicare has no such capital costs—we taxpayers simply send them money and they use it for their business.

Worse than that, Medicare is a Ponzi scheme that makes the original Charles Ponzi look like a small-time, turnstile-jumping criminal. The losses that Medicare is racking up are at the incalculable level, and there is no chance that tens of millions of Americans who are paying into this model will ever realize its promises.

Where does bankruptcy appear on the Medicare ledger? It is pretty easy to keep your expenses down if you simply do not pay them (at least for now). No, the administration expenses of Medicare are not 2 percent. They are actually much greater than any other insurance company in the history of the universe. They just have not been paid yet.

With regard to claims denials, Medicare denies reimbursement at almost twice the rate of private insurers. And even if they did not, is that a good thing? How much fraudulent Medicare billing (estimated to be tens of billions of dollars by the current administration) actually occurs anyway? Would this be much less if administrative dollars were used to deter fraudulent billing?

I do agree with Dr. Mills with regard to the private health insurers. They sometimes get away with murder, but the reason is not because they are profit-making organizations as Dr. Mills implies. It is because they have little or no competition. Why? Again, just look for the government’s role and you will have the answer. If an insurance company in any given state behaved the way Dr. Mills’ insurance company has, there would be other companies there in a heartbeat to fill the void, do a much better job and happily make approximately 15 percent for their effort. Why does this not occur in Dr. Mills’ situation? Extreme regulation of the insurance industry prevents companies from selling their products across state lines.

Guess who suffers in this lack of competition? That would be us. Guess who enables this situation to exist? That would be the government. Guess who believes that the problem of unnecessarily increasing medical-care costs is directly attributable to governmental interference in the free-market system? That would be me.

Richard J. Mackool, MD   
Astoria, N.Y.   

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The Value of Dialogue 

I was grateful to see “Saving Ophthalmology’s Endangered Subspecialties” (Feature, October) point out the vulnerability of some of the subspecialties.

In the story, Dr. James P. Dunn Jr. states, “You can’t quickly see a new neuro-ophthalmic patient in the way you can see a patient with a cataract or fairly quickly examine a patient with glaucoma because those conditions are limited to the eye and involve easily performed in-office imaging, not CTs or MRIs.” I doubt that this comment will find a warm welcome with those caring for patients with glaucoma. Obtaining an appropriate history from a patient with glaucoma is time-consuming. Considerations of a person’s general health are an essential part of the evaluation. In addition, there is surely no “wow” factor in fields such as glaucoma and ocular oncology, where slowing down visual loss or loss of life is all too often the most that can be accomplished.

The main point of this article is that what is probably the most essential aspect of medical care is not financially valued. That aspect is knowledgeable and caring dialogue.

Physicians who recognize the importance of listening carefully, knowledgeably and thoroughly to patients need to be more effective in convincing their colleagues, as well as all those in government who decide what payments will actually be made, that spending time with patients is at the heart of good care. This must not be in a way that devalues the importance of interventions but rather in a way that highlights the real benefits of competent care for both individuals and society.

George L. Spaeth, MD   
Philadelphia   

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Comprehensive Community Care 

I was very interested to read “Diabetes Upswing and the Economic Downturn: Call for Community Eye M.D.s” (Clinical Update, March).

In the city of Salina, Kan., annual screening for diabetic eye disease, a major goal of Vision 2020 USA, used to account for the majority of referrals out of the Salina Family Healthcare Center. All of the community ophthalmologists, including myself, provided screenings for the clinic’s uninsured patients at no cost, but at a considerable cost to the private office.

More recently we have developed an innovative way to address diabetes eye screening in our community while minimizing the financial impact on both community ophthalmologists and the patients. A donated slit lamp stays at the clinic and has allowed me to perform comprehensive, dilated eye exams for patients with diabetes, eliminating overhead costs and decreasing the need for referrals to other ophthalmologists. Patients who need additional care are then followed and treated by the ophthalmologists in the community along with vitreoretinal consultants from Wichita.

It is our hope that the successful implementation of comprehensive care in a family medicine setting will translate to better eye and overall health in an at- risk population. For more information, visit www.salinahealth.org.

Linda M. Lawrence, MD   
Salina, Kan.   

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Correction 

In January’s Academy Notebook, Girolamo Petrachi, MD (Italy), was not included in the list of International Ophthalmologist Education Award recipients. In fact, he earned this honor in late 2008. EyeNet regrets the error. For a full list of recipients, visit www.aao.org/international/awards/intawards.cfm.

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WRITE TO US Send your letters of 150 words or fewer to us at EyeNet Magazine, AAO, 655 Beach Street, San Francisco, CA 94109; e-mail eyenet@aao.org ; or fax 415-561-8575. (EyeNet Magazine reserves the right to edit letters.)


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