Letters to the Editor - 6/17/2009
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Medical reform with savings
Editor: The following addresses issues raised in your June 14 editorial, "Forgive loans for new docs."
This is a proposal to reform medical care and save the federal and state governments and the taxpayer trillions of dollars over the long run.
Federal and state governments would pay all costs of a medical school education for students who otherwise would not be able to afford a medical school education. No student would be excluded, provided that upon completing medical school, the doctor would be obligated to provide a percentage of his time and practice for treating low-income patients deemed eligible by federal and/or state governments.
The doctor would be obligated to treat a small percentage of eligible low-income people for free (office visits only). The percentage and number of years of obligation to do so would be decided by peer review. The less money provided to the students for their medical education, the smaller the percentage of their obligation for treating the eligible poor.
Participating doctors would not bill Medicare, Medicaid, insurance companies for the treatment of the eligible poor, thus saving the federal and state governments trillions of dollars in the long term.
The cost of the free medical school education provided by federal and state governments would be offset by the savings achieved by not having doctors bill Medicare, Medicaid and the insurance companies. Doctors would have the option to treat eligible patients in their office, at hospitals or clinics. Clinic space could be provided for out-of-office visits.
The same premise can be applied for health providers and care givers willing to participate under the same rules and obligations. The federal/state governments would defray all cost to all eligible health providers and care givers to open up their medical practice/office. Doctors, labs, chiropractors, radiologist, dentists and therapists would be eligible under my proposed program.
The potential saving to the federal/state governments from non-billing by participating care givers would be in the trillions of dollars.
Regarding unnecessary diagnostic tests that are ordered by doctors out of fear of medical malpractice, a meeting of the minds could be convened among federal and state policy leaders, bar association representatives, medical insurers, and health providers to come to an agreement of understanding as to limiting diagnostic tests deemed unnecessary.
JOSEPH P. MARTINO
MILLBURN, N.J.
Form crisis teams
Editor: Regarding the June 14 article, "Cops as Counselors": We cannot expect police officers to have the training of a mental health professional. However, it is necessary that they be provided some training on addressing the needs of those in crisis.
It is unfortunate that because of this lack of training that the potential for unnecessary escalation of crisis exists. It is unfortunate as well to see how dismal the mental health system is, which often treats people in crisis as objects, not people. For many individuals in crisis, both police and mental health professionals use force and coercion rather than compassion.
I recall in my work with a young man experiencing an extreme state of mind where he had delusional thinking and the hearing of voices. When police became involved, this often made him more afraid and agitated. I sought to connect with him, to build a relationship of understanding, and to join with him where he was. It took patience, but this was always a more effective means of de-escalation.
I suggest that there be a team of individuals to accompany police to crisis calls, people who may be familiar with the person in crisis as well as those with an appropriate level of training in dealing with crisis.
Some may argue about the inherent cost of such a program. However, I think it would be a huge investment in people's lives and offset the expense of unnecessary psychiatric hospitalization.
Lastly, I must comment on the choice of interviewing NAMI representatives as spokesmen for distressed people. This organization purports to be an advocacy group for the mentally ill. However, after Sen. Charles Grassley of Iowa requested information from this organization, it was learned that they receive vast funding from the pharmaceutical industry. This makes them spokesmen for that industry, not the true needs of those in distress.
DAN L. EDMUNDS Ed.D.
Tunkhannock
Alternative site
Editor: Regarding your June 12 editorial concerning the establishment of a methadone treatment center in Dunmore as well as resistance by the public and local officials to have it placed there, if I may be so bold as to offer a possible alternative to this predicament.
It is well known that many individuals suffer from multiple addictions. In light of that, would it not be better to locate this center in the Waverly area, in close proximity to Marworth, so that those with dual addictions have easy access to a "continuum of care" approach to treatment?
As is the case with addictions, there is also the co-existing pattern of depression and other psychological maladies. A treatment center in the greater Abington area would also offer the opportunity of treatment clinics for related psychological conditions at the Clarks Summit State Hospital. That facility has long been under-used.
The opening of drug-related depression units there could also prove beneficial to the development of additional jobs for area residents with experience in the areas of addiction as well as providing justification for keeping the CSSH site open in this time of governmental studies related to cost effectiveness.
Such pro-active geographically centered sites could ultimately prove to be the most demographically beneficial course of action yet considered.
LYNNE DUNCAN
Dunmore
Ease I-81 flow
Editor: A recent news article spoke again of the volume problems on Interstate 81 in Lackawanna and Luzerne counties. We again are being treated to multimillion-dollar schemes to widen this artery. This will not solve the problem - it will only encourage more traffic.
A solution for this problem has been in existence for 52 years. The problem can be solved to some degree by turning the "lightly used" Pennsylvania Turnpike between Pittston and Clarks Summit into a free road. Truck traffic north and south will actually save mileage with this route. This has been proposed before, but, of course, the architects and contractors do not want to hear about this proposal. I can now hear their checkbooks opening.
In closing, I was impressed with writer Charles Schillinger's comparison of the light rail plan to the New York City passenger plan. How true; this has been a "work in progress" now for 31½ years.
DONALD A. BANKS
Exeter
11 posted comments
Why Chiropractic Is in Trouble
Timothy A. Mirtz, D.C.The default rate for student loans is much higher among chiropractors than it is among graduates of any other health profession, Chiropractic leaders would like you to believe this situation exists because the loan program is flawed and reflects "discrimination" against their profession. The simple truth, however, is that the default rates signify that the profession itself is in deep trouble.The Federal Health Education Loan (HEAL) program was enacted under Public Law 94-484 and took effect in October 12, 1976. In 1981, Public Law 97-35 made chiropractic, health administration, and clinical psychology students eligible to borrow up to $12,500 per year for four years. In 1992, Congress raised the the maximum graduate students could borrow in federal loans from $11,500 to $18,500. Of this amount, $8,500 is available as a subsidized Stafford Loan on which the government pays interest while the student is in school. The remaining $10,000 is available through an unsubsidized Stafford loan, on which interest starts to accrue immediately. Borrowers obtain these loans through private lenders or directly from the federal government. Private lenders aggressively market their own loan programs to graduate students typically with rates pegged to the 91-day Treasury bill plus 2.4 to 3.25 percentage points while one is in school and rising to 2.85 to 3.5 points after graduation [1].From fiscal year 1978 through 1998, the HEAL program insured loans to over 156,000 borrowers and was a big help to chiropractic schools and their students. But as time went on, it became clear that the default rate of chiropractic graduates was very high. By 1991, taxpayers had lost an estimated $3.6 billion on bad student loans, and the Bush Administration recommended dropping chiropractic from the HEAL program [2]. Congress did not do this [3], but increasing debt (from $10 million in 1987 to $42 million in 1992) stimulated the Department of Health and Human Services to release the names of defaulters with the hope that public humiliation would pressure them into paying. Many media outlets responded by portraying the defaulters as "deadbeats, but some defaulters were portrayed sympathetically. In St. Charles, Missouri, for example, the local newspaper issued these contrasting reports: The U.S Attorney's office is looking for two "deadbeats" in St. Charles County who have defaulted on more than $200,000 in student loans. "We consider them deadbeats, even though they are professionals and graduates of chiropractic colleges," said Eric Tolen, assistant U.S.attorney [4].
The HEAL program ended in 1998. Today, chiropractic education is funded by a privatized version called ChiroLoan, which began in 1992 [6]. As far as I know, its default rates have not been publicly revealed. I have inquired several times but received no data."How's that Doubting Daryl??
If the vast amount of doctors didn't pay their student loans, then there would not be student loans, it's called market economics. 2. "chiropractors are the worst offenders", is just another example of the point I'm making, where did you get that from?
3. Student loans aren't eligable for bankruptcy proceedings 4. Medicine is a more lucrative trade than many others. Upon default, with the ability of bankruptcy protection, various forms of collection may be employed including wage garnishment (though, by law, not in PA), to garnishment on Fed. gov. tax refunds...
"The federal/state governments would defray all cost to all eligible health providers and care givers to open up their medical practice/office. Doctors, labs, chiropractors, radiologist, dentists and therapists would be eligible under my proposed program." It seems to be a wash.Also, historically it has a labor of Hercules trying to get new doctors under such arrangements to honor their agreements to give back a percentage of their time to treat needy patients. Same with student loans to doctors, who often abscond and become fugitives.
The issue of training is a problem and it is a leadership problem. In the military if a situation like this occured the whole chain of command would be fired and or officially reprimanded which would in effect end their career. Our city leaders refuse to be leaders. They are reactive rather than proactive. Training for different situations should be on going.
Our Mayor, public safety head and chief of police were all to busy to attend the DAs briefing concerning this terrible incident. They showed no leadership, compasion or support for thier officers, the Williams family and the citizens of Scranton. They should all be fired.
As usual this administration has decided to hide its head in the sand hoping it all blows over. King Chris at his finest.
"The federal/state governments would defray all cost to all eligible health providers and care givers to open up their medical practice/office. Doctors, labs, chiropractors, radiologist, dentists and therapists would be eligible under my proposed program." It seems to be a wash.Also, historically it has a labor of Hercules trying to get new doctors under such arrangements to honor their agreements to give back a percentage of their time to treat needy patients. Same with student loans to doctors, who often abscond and become fugitives.