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To the Editor:

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The capital botheration with our bloom affliction arrangement is that it is, at every level, profit-driven, from the doctor’s appointment to the biologic companies to the hospital. And no bulk how you get insurance, through the Affordable Affliction Act or your employer, they’re in the business of abstinent account to beforehand profitability.

No one should be accepting affluent off people’s misery. While doctors, hospitals and biologic companies charge to get paid for their services, C.E.O.’s shouldn’t be authoritative nine-digit salaries while patients suffer. The alone band-aid is universal, nonprofit bloom affliction for all. Is that Medicare for All, or article different? I’m not sure, but best added automated avant-garde countries accommodate bloom affliction as a basal right.

Daphne CaseNorwalk, Conn.

To the Editor:

My bloom affliction bulk abridgement account are:

1) Promote bulk accuracy by outlawing acquaintance agreements amid insurers, doctors, hospitals and added providers that avert acknowledgment of absolute arrangement agreement ante that accomplish it absurd for patients and doctors to analyze the best cost-effective high-quality providers.

2) Get medical abuse disputes out of the easily of juries and acting specialized bloom courts presided over by board empowered to appoint aloof experts to array through adverse claims. Also, accord doctors safe-harbor aegis from lawsuits if they chase evidence-based guidelines and protocols area they exist. This should abate arresting anesthetic over time.

3) Acquisition agency to admission the allotment of the population, abnormally amid the elderly, who assassinate a alive will or beforehand charge for bloom care. When there are no such abstracts and no advice from ancestors members, acquiesce doctors to exercise accepted faculty depending on affairs instead of accomplishing aggregate accessible to prolong activity no bulk how abortive or costly.

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Barry CarolAberdeen, N.J.

To the Editor:

I am all in favor of accepted bloom care. “Medicare for All” seems to be the ambulatory cry. I aloof appetite to point out one important affair — Medicare is not cheap. I’m 71 years old and accept been on Medicare for several years. It is an accomplished program. It has credible me and my bedmate through a brace of hospitalizations with little or no added cost.

But we pay for Medicare, over $260 per ages deducted from our Social Security checks additional allowance premiums for added allowance and the decree program, additional the doughnut aperture for a while longer. I booty a medication that is not on biologic formularies because of bulk and accept to diaphoresis whether I can get an barring every year.

If Medicare for All is aloof cipher for accepted bloom care, great. If it is actually Medicare for All, be warned: It ability be cher for lower-income people.

Elizabeth FisherEliot, Me.

To the Editor:

The arch problems with our bloom affliction arrangement are adequately clear: aerial cost, asperous admission beyond socioeconomic echelons, poor outcomes for poor people, and abridgement of portability of allowance from one job to the abutting and from one area to another.

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Here are what I anticipate ability go some agency against analytic these problems. First, acquiesce all individuals and administration to be able to accept Medicare as their insurer, ambience premiums to acquiesce a assets basin to awning the unemployed, disabled, alive poor and busted elderly.

Second, decouple agreement to providers from the aggregate of account provided and articulation it to outcomes.

Third, accommodate chargeless medical training to all able nursing and medical students.

And finally, advance a abundant beyond core of abettor practitioners to accomplish accepted interventions for nonemergency, non-life-threatening situations.

Richard GayleVentura, Calif.

To the Editor:

I am advantageous abundant to accept appropriate bloom allowance through my employer. However, this agency that if I appetite to about-face jobs, for a bigger bacon or a job that bigger apparel my career goals, I may accept to go afterwards bloom allowance for a chancy aeon of time, or pay the absonant Cobra costs. I would additionally be added afraid to assignment for a baby aggregation that may not accommodate bloom insurance. Wouldn’t we be served bigger if bodies could accompany their careers afterwards accepting to anguish about accepting employer bloom allowance coverage? This is why I abutment the New York Bloom Act.

Isabella VittiBrooklyn

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To the Editor:

What works in American bloom affliction is the amazing technology we advance and employ. Our analysis hospitals are article we can be appreciative of.

Three things that don’t work:

1) Funding of medical education, which puts new doctors into so abundant debt that they are affected to accept higher-paying specialties over primary affliction and underserved populations;

2) Our complicated and inefficient acquittal arrangement (we absorb abundant added than added countries on overhead); and

3) Our adamant affirmation that bloom affliction is a artefact for auction if you can allow it rather than a basal animal need.

Charles E. BouchardSt. LouisThe biographer is chief director, canon and ethics, at the Catholic Bloom Association.

To the Editor:

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When I began my new job in 1975 as the banking administrator at a primary affliction clinic, I was abashed at how few primary affliction doctors were in the association and how little money went to primary affliction and blockage services. As I adapt to retire, I am saddened, but not shocked, at the accompaniment of the American ailing affliction (not bloom care) system.

We charge to acquisition ways, big and small, to advance added money upstream to armamentarium prevention, aboriginal intervention, primary care, affordable housing, abandon blockage and so on. If done thoughtfully, we can activate to boring abate the cardinal of “customers” of the ailing affliction arrangement — bargain emergency allowance visits, hospital admissions, analytic imaging procedures and specialist visits. This would chargeless up a hasty bulk of money that could be confused upstream, creating a blameless advancement aeon that will aftereffect in a accurate “health affliction system.”

It’s accident appropriate now, accurate by adolescent bodies and aware administration who are abnegation to comedy in the old game. I’m aflame and optimistic.

Dale JarvisSeattle

To the Editor:

The six-year aeon that I spent afterwards bloom allowance — continued afore the Affordable Affliction Act became law — was a alarming experience. Even afterwards I acquired allowance aloft re-entering the assignment force, I spent so abundant money on account payments, co-pays and deductibles that I could almost allow basal necessities.

The accepted law is a collection that charge be ashore in a stronger, added reliable system. A affairs is bare to agreement that all citizens with bound assets are insured while those who are bigger off pay for allotment or all of their insurance.

I accept in apperception a multi-tier system. A government affairs would be accessible for anyone who cannot allow bloom insurance; middle-income bodies could accept amid the accessible plan and a clandestine insurer at reasonable cost; and the affluent would be appropriate to acquirement clandestine allowance at college costs.

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Bruce S. TickerPhiladelphia

To the Editor:

I advance that our bloom affliction arrangement could do bigger in communicable complications from any surgical procedure. A account of specific complications could be accustomed anniversary accommodating at discharge. It charge be accessible to apprehend and actual bright on what to do if any aggravation becomes apparent. This could potentially abate the cardinal of echo hospitalizations for big-ticket inpatient additional surgeries.

Gary S. SorockPittsburghThe writer, a registered nurse, is an accessory abettor assistant at the University of Pittsburgh School of Nursing.

To the Editor:

I am an accomplished bloom affliction provider who couldn’t accumulate my backward babe safe in our medical system. I abstruse aggregate I apperceive now the adamantine way — by watching my babe ache through medical errors, misdiagnoses and advice glitches.

I account my daughter’s anamnesis by alive as a advance accommodating apostle to accommodate the advice that I bare all those years ago to the public. The actual aforementioned issues my ancestors faced abide to affliction the patients and ancestors associates who consistently acquaintance our alignment — two decades later.

We accept fabricated little advance in absolutely educating and agreeable patients and their admired ones to booty an alive — and potentially lifesaving — role in their medical care.

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There are few bloom affliction strategies that are added cost-effective or allotment than allurement the appropriate questions, authoritative abreast decisions and accepting the abilities to action as the aftermost akin of aegis in the aerial assurance net for patients.

Julia HallisySan FranciscoThe biographer is the architect of the Empowered Accommodating Coalition and EngagedPatients.org.

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