FP Report -- November 1999
Letters
Genetic risk factors, universal coverage
To the editor:
Three reports in the July 1999 FP Report compelled me to write. Let me first explain that I am retired from clinical practice, and my only gainful employment is doing life insurance exams on and collecting specimens from applicants.
In the July issue's section on medical genetics, concern was expressed that the results of genetic tests could be used to deny or rate life insurance policies. How does this information differ in principle from all other information that is used to assess actuarial risk? Why is it unfair to charge higher premiums to those who are at greater risk of early demise and charge lower premiums to those eligible for "preferred" rates? Whether or not there is effective treatment or prevention for "risk factors" may have a bearing on rating but I think not on the basic concept.
Another July issue article, "Medical Groups Seek Universal Coverage," deals with health insurance. Please excuse me for being a dinosaur, but I have never thought it was a good idea to pay a large, faceless bureaucracy to pay my bills in the cloak of an insurance policy. I would not have health insurance (except for catastrophic coverage) were it not that one without coverage is charged more than the insurance companies are charged. I know the rationale is that most uncovered people can't or won't pay anything, so the charges are made higher to the uncovered who can pay. I really don't think this strategy motivates the financially irresponsible or the impoverished to get insurance.
Arguably, there are other intangible benefits to health insurance for the insured, e.g., "peace of mind," relief from budgeting and cost control provided by the insurance company. But these (and possibly other) benefits are not free. They raise the real cost of medical care, and the consumer should have a choice. If consumers were getting the rebates they deserved by paying their medical bills directly and promptly, the number of people with full coverage would probably drop even more.
Universal coverage can only come by increasing government intrusion of the kind detailed in a third July FP Report article, "Idaho FPs Speak Out Against HCFA Audits." Aren't we getting carried away by the liberal element in our midst? Normal, routine medical care should not require insurance. If people can't afford to pay for routine care, they can't afford the insurance premiums either.
To its credit, American medicine (AMA) opposed health insurance in the early days, but they lost the battle. Yet, it appears to have been a financial boon for the profession. To me, therefore, this push for universal coverage looks too self-serving.
By the way, I like FP Report's change from "house organ" to news.
FRANK LEITNAKER, M.D.
Miesau, Germany
Use national center to help children with disabilities and their families
To the editor:
I'm writing to let family physicians know more about resources for children with disabilities.
Families typically first consult their child's physician if they are concerned about development or possible disability. They turn to physicians for help -- for the child and for the family -- so they can best meet their child's needs.
If a child exhibits developmental problems or has a disability, there are many resources in the community. There are early intervention services for infants, preschool programs for toddlers, and school services for youngsters of all ages and all abilities. Each state has disability organizations and state agencies available to provide assistance to schools, homes and communities.
What's needed is someone to make the referral, to initiate the connection between families and all the possible resources. The National Information Center for Children and Youth with Disabilities -- also known as NICHCY -- has information for professionals and families and provides these connections. The center is funded by the U.S. Department of Education; we serve all inquirers and cover all disabilities. Physicians can use the center's materials and the Web site or refer families directly. All services and most materials are available free of charge.
We invite you to call the center at (800) 695-0285 to request our catalog, or you can go directly to the Web site at www.nichcy.org.
SUZANNE RIPLEY
NICHCY -- Washington, D.C.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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