<CENTER><B>Letters to the Editor</b></center>

Unbalance Health Care Dollar

By Dr. Bruce Bethancourt

It was recently reported in the East Valley Tribune that health care coverage, primarily for employer-sponsored plans, will be increasing dramatically for 2004, averaging as much as 18 percent across the board.

According to these articles, these increases are needed to offset losses from the previous year. This may be true, but these "facts" are getting harder to swallow when we also read that, in Arizona alone, HMO quarterly profits have skyrocketed to $87 million for the third quarter of 2002.

Articles have also reported that compensation for HMO CEOs and board chairmen are astronomical, by anyone's standards, like Wm. McGuire MD, of United Health Group, who is reported to have earned $9,457,397 in 2002.

These CEOs are not only lining their pockets, they are also eroding the foundation of medical care that is already in danger of crumbling in this country. HMOs, and other payers, often reduce the rate of reimbursement to providers, while raising the "hassle" factor so high that it seems the overall strategy is to make it difficult for providers to take care of patients. No care, or less care, means raising profits-all at the expense of the patients they are being paid to take care of. Patients lose, doctors lose, and corporate CEOs and stockholders win.

There is already a measurable impact in Arizona, which is easy to see. I know as a referring doctor, I am lucky if I can get one of my patients in to see a physician in a certain specialty, because we have a serious shortage and we're not alone. Recently, California became so desperate, it figured out a way to import 30 physicians from Mexico to staff several non-profit clinics.

Don't forget that the average medical student in this country comes out of medical school owing nearly $150,000 in medical schools loans. With the way things are going, new physicians will not be able to pay back loans and still set up a practice. It's little wonder that there is a growing physician shortage, fanned by reduced reimbursements, that make the business side of medicine the primary focus-out of necessity for survival-rather than patient care.

Where are all these costs coming from? Is it just doctors and hospitals? A recent New England Journal of Medicine article reviewed costs of health care administration. It reported that in the US $294.3 billion is spent on health care administration. That means that, in our country, 31 percent of every health care dollar is spent on administration of the health insurance system, and not on actually providing care. If you apply these numbers to Arizona, my math says this means $.31 of every dollar spent by employers and employees, goes to administrative non-medical costs, including compensation for corporate executives, at the expense of treating patients the way I know we can, and should, but are not.

To me, having trained and practiced in Arizona for the last 30 years, the outlook for the future of health care in Arizona is bleak. The solution to the crisis of medical care costs, created in large part by health insurance and HMO corporate philosophies, is not unlike the fictional scenario described by Ayn Rand in her book "Atlas Shrugged." The characters of this novel decided to deny their knowledge and experience rather than to labor as little more than beasts of burden for unforgiving and demanding masters. The great minds of this fictional scenario decided to simply shrug and walk away.

To me, it is time for physicians, patients and employers of Arizona to walk away from health plans and HMO coverage that puts profits above service, and demand that premium dollars be utilized for quality health care, and not corporate compensation and dividends.

Bruce Bethancourt, MD, FACP, is the 112th president of the Arizona Medical Association.

Get over the 2000 election already


It is truly amazing how long some folks hang onto their "sour grapes" attitude, as evidenced by the letter from Mr. Purtymun on Friday. As I recall, Mr. Bush did win the electoral vote (obviously) and probably the popular vote, except for the political chicanery attempted by the other candidates.

I dread the thought of what the situation would be today if Mr. Gore and Lieberman were in President Bush's shoes. After the previous two Clinton administrations, it certainly is great to have the moral adults back in charge of our nation. The Clinton years only showed that America is strong enough to survive nearly anything.

James Miller

Camp Verde

Thanks, firefighters, for great event


On Sept. 10, Oak Creek School held its annual cross-country meet. It was successful and very positive for all of the students involved.

One thing that helped the meet to be such a success was that the Verde Valley Fire Department was on hand to help with traffic and any medical emergencies. This is not the first time the fire department has helped out Oak Creek School with the cross-country meet. They have been doing it for years.

I would like to thank all the firemen involved for helping at all our cross-country meets and for being positive roll models to the youth in our community.

Donnie Shanks

Athletic Director

Oak Creek School


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