Blue Double Cross

I read Paul Krugman's May 22 column in the N. Y. Times and entirely agree with his view of the for-profit health care insurance companies. In the 47 years that I've been a family physician, I've seen these insurance companies evolve from not-for-profit patient orientated providers to the rapacious gang they are today. As a young doctor, I could rely on the insurance providers to see to it that my insured patient's medical necessities were promptly covered within the clearly descibed limits of their policy.
There were many people who had no health care insurance. The government partially reduced the size of the uninsured population by legislating single-payer plans for the indigent and those people age 65 and over, (Medicaid and Medicare.) Those programs exist today and cover almost one third of our population. They limit the amount they pay for services, but the guidelines clearly state what is covered and the remuneration for each service.
The Medicaid and Medicare programs are not "socialized medicine," as the opponants to single-payer lead the public to believe. They do not directly employ care-givers and other providers, or own the hospitals or laboratories. The Veteran's Administration program is an example of a government owned single-payer system. Everyone working for them is on a fixed salary and the hospitals and clinics belong to the government. Yet it's considered one of the best health-care providers in the Country.
The private for-profit health insurance companies are actually more expensive than the government plans, because of their need to make profits. Insurance company profits do not pay for patient care. The patch work nature of the industry also costs the patient-care providers more time and money.
My letter to the Times is a brief response to Krugman' excellent column.
Melvin H Kirschner, MPH, MD, Family physician

To the N. Y. Times:

As a family physician for 47 years, I totally agree with Paul Krugman’s May 22 column “Blue Double Cross. Healthcare insurers are “more bureaucratic than any government agency. They deny choice of doctor, and sometimes refuse to pay for care.”
My experience with the government programs, Medicare and Medicaid, is that the reimbursement for services are low, but there is one uniform set of rules to follow.
Each healthcare insurer has a different set of rules. The reimbursement for services varies widely and the doctor sometimes doesn’t know where to send the patient for laboratory or other tests. Furthermore, the physician often doesn’t know whether the prescriptions they write will be covered.
As Mr. Krugman reports, “Insurance companies are still bad for your health.”

Melvin H Kirschner, MPH, MD