A letter from a reader: Debating health care: A response

July 16, 2008:

Dr. Gary Fields '61 has a very different opinion of managed care (Letters, May 14) from his perspective as a "physician executive working for an integrated delivery system" than I have as a practicing cardiologist caring for sick patients for the past 40 years. Not only has managed care frustrated patients and their physicians, but it can delay health care delivery and cause considerable harm. I recently served as an expert witness at a malpractice trial; a very ill 23-year-old woman in an HMO setting was denied prompt hospitalization, which greatly contributed to her death from acute myocarditis. When people's health and lives are at stake, a hypothetical "model" that cannot be effectively implemented, after decades of trying, should be abandoned.

Dr. Fields has suggested that I "check the options available." One option would be to dismantle those bureaucratic health-care systems whose goal is to ration medical care in order to enrich their bottom line and enhance executive bonuses.

I disagree with his remark that "insuring everyone is not a viable solution." He might consider reading or re-reading the health care chapter in The New American Story by former senator Bill Bradley '65, who favors a properly administered single-payer system.

Re Professor Uwe Reinhardt, I am pleased that I have his attention but disappointed in his response (Letters, June 11). He fails to explain why, now that managed care is prevalent, the cost of medical care keeps rising and, despite technologic advances, the quality seems to be deteriorating. The obvious answer is that too much of our health-care dollar is diverted to fund the administrative bureaucracies of insurance companies and managed-care operations and less is spent for the direct benefit of patients. Increasingly, physicians and patients are held hostage to these inflated bureaucracies. As a result, experienced physicians often retire early and more patients have inadequate or no health insurance.

As for Mr. Reinhardt's directorships, he is also a director of Boston Scientific Corp., a medical-device company that makes cardiac pacemakers, internal cardiac defibrillators, and coronary stents. He is "amused" by my comments, but it is hypocritical to criticize physicians for their "taking from these treasuries" while his fees and perks as a director only increase the cost of these expensive lifesaving devices. He mistakenly equates his for-profit endeavors and motives with those of most physicians who have dedicated their entire professional lives to training, research, and patient care.

Lastly, his one-liners about the medical profession resurfaced on campus at the health care conference as part of the 2008 Reunions. These quips, couched in humor, are not new and are counter-productive. Now, more than ever, idealistic bright Princeton students should be encouraged (not discouraged) to pursue a time-honored career in medicine.

HOWARD J. ZEFT '58, M.D.
Fox Point, Wis.

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