Don’t blame fee-for-service for all of healthcare’s ills

Regarding the June 30 editorial (“Insuring against the future,” p. 24) this article is another attempt to sell Americans on the notion that fee-forservice is the cause of our healthcare spending woes and must be abolished if we hope to get spending under control. As in other such articles, this assertion is justified by stating “system leaders are stuck with a reimbursement system that still rewards volume,” as if high volume of work and high quality cannot mutually exist. And going further to state that the “margins at hospitals performing one complicated surgery rose from $17,000 to $56,000 after things went wrong” blatantly suggests that surgeons might actually be deliberately causing complications so they could be paid more.

Fee-for-service incentivizes specialists to work as hard as necessary to keep up with fluctuating volume demands in their practices, keeps physicians accountable to patients, not bureaucrats, and encourages adherence to the ethical principles upon which medical practice is based—keeping what is best for patients the overriding basis for all medical decisionmaking.

Elimination of fee-for-service for specialists will create the exact situa- tion we see in the VA health system: patients waiting inordinate amounts of time for care and the awful consequences that result for the patients and their families. Dr. Thomas M. Flake Jr. Southfield, Mich.