Public health insurance, a necessary alternative to private insurance

June 24, 2009

Danbury News Times
Letters Editor

In the June 24 article “President battles insurers over his health plan”, insurers complain that a government health plan would disadvantage them because they would not have a level playing field to operate on.

But insurers should not expect sympathy from patients or doctors. They have accumulated almost monopolistic powers over the past few decades precisely because they “owned” the playing field and made sure that it wasn’t level for anyone besides themselves. It has allowed them to bully doctors and underpay them with a like- it or leave- it approach. And it has allowed them to exploit patients by raising their premiums, while they reduce what they will pay for drugs, testing, and doctors’ visits. This accounts for their tremendous profits and the exorbitant salaries they pay their CEOs.

A government plan would finally inject some real competition into the health care insurance market.

No wonder private insurers are worried!

Ed Volpintesta MD

Younger physicians' idealism drives public health insurance

June 26, 2000
The New York Times

Regarding “ The Prescription From Obama’s Own Doctor” (OP-ED, June 25): It is encouraging to read that the American Medical Student Association strongly supports public health insurance. Often younger physicians’ idealism affords them the ability to envision the future of medicine more clearly than their older colleagues whose vision is often clouded by a timid conformity that impedes progress and perpetuates the errors of the past.

Ed Volpintesta MD

Medicare is not mediocre

June 26, 2009
New York Times

Re “The Only Public Health Plan We Need” (OP-ED, June 25): To suggest that “Medicare is a “mediocre-quality insurer” is wrong. If the goal is to mislead the public with prejudices and misconceptions as do all opponents of public health insurance, why no just call it socialized medicine, a scare-tactic that has halted progress of public health insurance for over fifty years.

Millions of Americans would have undergone bankruptcy if they were not protected by Medicare. I have not seen or heard of any Medicare patients having their cancer treatments denied or their insurance cancelled because of pre-existing conditions something that happens not infrequently with private insurers.

Clearly, Medicare is not mediocre, mercenary, or merciless, common complaints often hurled, as they should be, at private insurers.

Ed Volpintesta MD

Role of defensive medicine as driver of health costs understated

Dr. Atul Gawande wrote an interesting article in the New Yorker. By studying a Texas town with unusually high health care costs, he concluded that the incentives for doctors to be paid separately for each patient and procedure and in some cases fueled by an entrepreneurial spirit were responsible for the unusally high cost of health care there; and how this approach may be responsible for high costs of health care everywhere.

The article was good particularly his suggestions how doctors in their local communities could control health costs but his conclusion that the fear of malpractice threats and defensive medicine did not raise the cost of health care are questionable.

Here is my response to The New Yorker.


June 7, 2009
The New Yorker Magazine

I have difficulty accepting Atul Gawande’s conclusions about defensive medicine (the ordering of more tests than necessary in order to have a good defense in case a malpractice suit is filed) in his June 1 article “The Cost Conundrum”.

He suggests that because Texas’s malpractice laws have a $250,000 cap on pain and suffering, doctors they are not under acute pressure to practice defensive medicine, that is, order more tests than necessary in order to have good defense in case a suit is filed.

He based this on a cardiologist he interviewed who mentioned that malpractice cases had gone down “practically to zero”.

But Texas Liability Trust, the largest liability carrier in Texas reported only a 50% reduction in malpractice suits according to an article published in the September 8 issue of American Medical News, the official newspaper of the American Medical Association.

Even if the number of malpractice cases filed were “practically to zero”, doctors would still practice defensively because undergoing one is a terrible ordeal. No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career.

The fear of malpractice suits is one of the factors that contribute to the high cost of care in Texas as much as it does anywhere and until a more humane method of treating malpractice cases is established—one that does not destroy doctors’ reputations, or cause them unnecessary distress as they wait on tenterhooks waiting for the outcome of a case—doctors will continue to practice defensively.

The solution to the cost conundrum includes reforming the malpractice laws.


Edward J. Volpintesta MD

Insurers only partly responsible for primary care shortage

June 7, 2009 YJHM

In the June 7 issue of the Boston Globe, Dr. Stephen J. Bergman wrote an interesting OP-ED piece , “Pitting doctor against doctor” in which he expresses serious concern for the plight of primary care doctors, especially their low compensation rates compared to specialists.

He blames health insurers for their tactic of proposing to pay primary care doctor more by paying specialists less. Pitting doctor against doctor, as he calls this approach is a bad idea. It is a bad idea but there is another side to this argument.

Here is my answer to the editors at the Boston Globe



June 7, 2009

The Boston Globe

In his June 7 OP-ED piece “Pitting doctor against doctor”, Stephen J. Bergman MD is only partly right to put the blame on insurers for the low compensation rates given to primary care doctors.

Leaders of organized medicine have known about the unfair disparity between primary care and the specialties for decades. However most of the twenty-four medical specialties have largely ignored the plight of primary care. The majority of the specialties and their leaders have pursued a policy of protecting their own turfs, so to speak, and have left primary care on its own.

Outnumbered in the political arena, primary care’s approach has been woefully ineffective and their dominant attitude has been one of inurement and desperation more than effective advocacy.

Arguably, the internecine arena that health insurers have instigated may be viewed as a natural evolution of primary care’s fight for survival. Saving primary care is not the responsibility alone of the insurers. It is the responsibility of the entire medical profession.

So far, both have failed.

Ed Volpintesta MD