Getting the Best Advantage for Medicare Patients

Scott Gottlieb states in "What's at Stake in the Medicare Showdown" (op-ed, June 24) that private insurance companies are much better at making decisions about patients' clinical circumstances. Medicare has its foibles, but I have been impressed that Medicare has been far more conscientious about covering effective treatments compared to private insurance. I cannot tell you how many letters I have had to write to convince private insurance companies to provide treatments that not only result in an improved outcome, but also save the insurance company thousands or tens of thousands of dollars. Private insurance companies seem to default to a "no-payment" mode regardless of how illogical it may be.

Dr. Gottlieb also suggests that Medicare Advantage plans represent an unqualified success. In reality these plans have simply brought all of the hassles of private insurance into the realm of Medicare.

Jonathan D. Walker, M.D.
Fort Wayne, Ind.

The traditional Medicare program withers on the vine at the expense of access to care for the 80% of seniors and disabled who rely on the program. Despite naysayers' claims, the bipartisan legislation to fix a July 1 Medicare payment cut of 10.6% to physicians will not cut Medicare Advantage benefits to seniors. The bill, passed by the House 355 to 59 and blocked by Republican senators, will simply make common sense changes to allow these plans to work better and ensure that vital Medicare dollars are going to patient care.

Many physicians are added to Medicare Advantage plans unknowingly. The bill will provide more transparency and ensure that insurers form a real network of physicians, rather than "deeming" them participants because they treat one patient who is part of a plan.

Duplicative payments to Medicare Advantage plans for medical education will be eliminated through the bill. The extra funds that threaten the long-term health of the Medicare program are too often just another bonus for insurers -- at the expense of patient care.

As supporters of Medicare Advantage programs cry wolf, the Medicare payment cut goes into effect in July, and will force physicians to make the difficult decision to limit the number of Medicare patients in their practices. Without access to a physician, it's not going to matter whether seniors rely on traditional Medicare or Medicare Advantage.

Nancy Nielsen, M.D.
President
American Medical Association
Washington

Dr. Gottlieb's friend should have asked a social worker instead of a health-care lobbyist for advice about care for her father after a hip replacement.

As Dr. Gottlieb knows, a hospital will release a patient to go home if he is safe to go. For at least the first week after a hip replacement, an older patient will be shaky on his feet even with a walker. At a minimum, he needs someone to keep an eye on him whenever he walks or uses the bathroom. He benefits from daily physical therapy. He should have a skilled provider available to identify any post-surgical complications.

However, Medicare cannot be expected to provide money for 24/7 supervision of a single patient in his home, and daily visits by a physical therapist, if there is a more cost-effective option. I doubt that a Medicare Advantage program would have provided more, and it surely would have narrowed the patient's choice of nursing homes.

Dr. Gottlieb's friend had several alternatives. Her father could have purchased a "Medigap" plan, private insurance which supplements Medicare. (Of course, people cannot wait until they are sick to enroll.) She could have paid out-of-pocket for whatever Medicare did not provide at home. Or, she could have done what many families do for patients not covered by Medicare: provide the unskilled labor herself. She could have moved in with her father, or had him move in with her.

Finally, there is no reason taxpayers should pay 12% more (the average difference between a Medicare Advantage Plan and traditional Medicare) for her father than for seniors receiving traditional Medicare.

Caroline Poplin M.D., J.D.
Bethesda, Md.

I readily agree that much more is needed to pay for long-term care. Nonetheless, the public Medicare program does not push people into nursing homes. Medicare's home health benefit covers nurses and home health aides for people who meet coverage criteria for as long as it is medically necessary. Medicare's nursing home coverage is only for 100 days.

Judith A. Stein, Esq.
Executive Director
Center for Medicare Advocacy, Inc.
Willimantic, Conn.

The U.S. Should Rethink Its Position on the MEK

Amir Taheri's assessment of the People's Mujahedeen of Iran (MEK) ultimately undermines his own argument for retaining the group on the U.S. list of foreign terrorist organizations ("Iran's Troubling Opposition," June 26).

Mr. Taheri is correct that the MEK has been long appreciated by Western and Arab intelligence services "for its sources deep inside Iran," and that "the group was the first to provide evidence of Tehran's secret nuclear project." He also accurately notes that "the MEK continues to enjoy much support inside Iran and among Iranian exiles," and that "no other political group has sustained so many losses at the hands of the mullahs."

Mr. Taheri is mistaken, however, when he claims that MEK members in Iraq have been extended "prisoner-of-war protection" by U.S. and coalition forces. In fact they are protected persons under the Fourth Geneva Convention, a designation reserved for noncombatants, and fundamentally at odds with a "terrorist" label. Moreover, Mr. Taheri's assertions notwithstanding, the MEK has indeed renounced violence, and is committed to working for secular, democratic reform in Iran. In 2003, MEK members at Camp Ashraf submitted verifiable signed pledges of nonviolence to coalition forces. U.S. security agencies have vetted each member and concluded that they have no links to terrorism.

Mr. Taheri's history of the MEK is deeply flawed. But rather than dwell on the past, let's regard the MEK's current position. The organization has taken the very steps Mr. Taheri advocates by renouncing violence. The MEK has repeated a willingness to cooperate with any international authority such as a U.N. fact finding commission to respond to any charges made against the MEK by Iran or its proxies in Iraq.

As Mr. Taheri notes, the British Parliament, following a high court mandate, has dropped the MEK from its terrorist list, based on the finding that the organization is not linked to terrorism. The U.S. should follow the lead of its ally in the war on terror and remove the unjustified "terrorist" designation from the MEK.

Lord Corbett
London

(Robin Corbett is a Labour Member of the House of Lords and is Chairman of the British Parliamentary Committee for Iran Freedom.)

Nonviolence Is the Essential Idea

Regarding James K. Glassman's "How to Win the War of Ideas" (op-ed June 24): The acceptance of violence as a means to political ends has been adopted by some religious organizations for a simple reason -- It has become highly effective. There was a point in the 20th century, behind the efforts of Mohandas Gandhi and Martin Luther King, when it appeared nonviolent resistance was the most effective method to achieve equality and political goals.

But later in the century, the West began to rationalize the actions of groups that adopted violence, which has been rewarded politically in South Africa, Palestine and other parts of world. Instead of refusing to sanction South Africa until opposition adopted a nonviolent path, we forced South Africa to end apartheid in the midst of frequent terrorist attacks. The victims of apartheid achieved their political goal, a noble goal at that, and those in the world who felt oppressed learned a dangerous lesson. Suicide attacks in Israel are typically rationalized by Western media as the only option for a desperate people. Martin Luther King knew there were other options. We rationalize violence when it is done to others, and then act shocked when terrorists attack us.

In order to win this ideological battle, the West needs to stop asking "why do they hate us?" and categorically reject any group that uses violence to achieve its political goal. When we negotiate with these groups, we legitimize violence and encourage other groups to adopt it.

Daniel Bryant
Colorado Springs, Colo.

Failure Isn't Illegal, but Lying Is

Robert Mintz is correct: It's not against the law to go broke or bankrupt -- happens all the time ("Business Failures Are Not a Crime," op-ed, June 26). What is against the law is lying to stockholders when you know that your company is going down the tube but fail to mention that minor little detail.

Mr. Mintz believes that the two Bear Stearns hedge fund managers have been singled out simply because "these two were among the first to see their funds implode" with the defense that they were not alone. "But officer, I was just driving with the traffic flow at 87 miles per hour down Interstate 95. Why didn't you give all those other guys a speeding ticket too?"

Corporate executives, management and officers of publicly traded companies get paid handsomely for their services. At least one of the bullet points in their job descriptions is to provide timely, truthful information to their stockholders. Is it criminal when they fail to do this? Right. By the way, there's probably another bullet point that says: Obey the law.

Jim Bowman
Raleigh, N.C.

Is It the Earth Yes, But People No?

Joseph Rago's piece "A Planet Without People" (Taste: de gustibus, June 20) says exactly what I have come to believe. The environmentalists' true wish is for all the unenlightened masses to disappear and leave the earth to those who can truly appreciate it. Sadly, they haven't yet found a method for eliminating humans selectively.

Meanwhile, look for more and more social pressure, and possibly laws, to limit the number of children couples can have. Elimination of the unfit (mentally ill, physically handicapped or simply old) will be examined, and seen as a humane solution to many of our problems. Suicide will be regarded as a sacrificial act. We are in danger of being brainwashed into a culture of death.

Mary Harrison
Newport News, Va.

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