Dear Editor,

Dr. Weaver’s editorial, “Physicians Hear This: Say Goodbye to Third Party Payment or Die” (Medical Sentinel, Jan/Feb 1998) makes the correct assessment that the profession of ethical medicine will die if we continue with third-party reimbursement. We will become shills of the state, unless patients pay us fee-for-service. However, I believe Dr. Weaver is wrong in believing there is something that physicians can do alone. It will be a lonely place not to accept third party payments because 85 percent of U.S. medical care is paid by third-parties.

As I see the problem, it has to do with money. While the third-party payers have the money, nothing good will happen. Therefore the solution is to get the money back to the patients. To do this, patients must get all their pay. Now a typical working family takes a net paycheck home of $33,000. If they got all their pay, they would have a paycheck of $50,000. Withheld from their pay is $4,000 of income tax, $6,000 of Social Security, and $7,000 of job-based benefits. A 509b increase in their net pay would cause a change for the better.

When these working families get all their pay, they will make the right choices. When they get all their pay, they will see it is in their best interest to pay for their own health care. They will decide how much health insurance to get and whether it is cost effective to have managed care. They will decide how much to save for their retirement needs in order to pay for and control their own health care choices.

I thank Dr. Weaver for his excellent commentary about how the profession will die if we do not return to fee-for-service.

Bert A. Loftman, MD
Atlanta, GA

Dr. Weaver Responds

 I thank Dr. Loftman for his perceptive comments on my recent Medical Sentinel article, “Physicians Hear This: Say Goodbye to Third-Party Payments or Die.” I agree that, as Dr. Loftman says, “it will be a lonely place to accept third party payments because 85 percent of U.S. medical care is paid by third-parties.”

First, I have never said it will be easy. If American medicine is faced with the choice — which I believe it is — of preserving the profession, or becoming “shills of the state,” I would rather choose the lonely road than follow the herd into serfdom.

In today’s practice environment, I do not believe the road ahead is clear to anyone. We physicians must begin to construct that path which will lead to salvation of our profession: Promulgation of medical savings accounts and catastrophic insurance, and pushing private contracting rights in Medicare are just two areas where we can begin to direct our profession down the road to freedom.

Finally, this is not merely a struggle for the preservation of American Medicine, because of the political interests involved; it has clearly become a struggle for the very survival of the fundamental traditions of this once great country.

God Bless Dr. Loftman (Libertarian Candidate for U.S. Senate in Georgia). I thank him for his comments.

James P. Weaver, MD
President-Elect, AAPS
Durham, NC

Originally published in the Medical Sentinel 1998;3(3):70-71. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).