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Medicine, Money, and the Uninsured

Judging by reactions to "Fresh pain for the uninsured" (Cover Story, Dec. 3), the high cost of health care gets the blood flowing. While we heard from some readers who blamed patients for failing to read the fine print in their medical documents, most were outraged by what the article described: service providers and financial firms converting medical debt into high-interest consumer debt to extract money from uninsured patients. ("Devastating," New York Times columnist Paul Krugman called it in his blog.) A number of readers also pointed to this: Unlike insured patients, who are billed at a discount under providers' agreements with insurers, the uninsured are often charged full price for medical services.—Brian Grow and Robert Berner

Your article makes a good case for extensive federal regulation, especially of hospitals, which charge the uninsured up to five times as much as they get from Medicare for the service.

Walter Gerhold, M.D.

Osprey, Fla.

How about people read the fine print instead of ignoring it? Medical offices and companies should not be held accountable for people who pick a financing option they choose not to learn about.

Screen name: SMB

This is why I moved to Canada. Even people with good jobs and advanced degrees [in the U.S.] are in danger of bankruptcy if a health issue arises. And [President George W.] Bush [signed a congressional bill to change] the country's bankruptcy laws to protect credit-card companies.

Screen name: AxelIDC

The article didn't mention one potential consequence of this type of medical financing. Back when I worked for a mortgage lender, I saw that unpaid medical debts listed on credit reports were not included in determining a borrower's ability to pay. But if a creditor like GE Money Bank [which finances medical debts from the uninsured] were to show up on a credit report instead of some doctor or hospital, then it would be difficult to discount such debt from the underwriting process. This means a borrower could be denied a loan or be required to pay higher interest on it—a sort of ripple effect.

James Stevens

Glendale, Calif.

As a Christian and a Republican, I am outraged at the liberal bias in this article. Privatized health care creates jobs and provides far better care than socialized programs in France, England, Canada, and the rest of the world.

Screen name: Dan F.

The real tyranny in the attempted monetizing of these medical bills is that the balance consistently exceeds the real cost of the services. Medicare, Medicaid, and, to a lesser extent, other third-party payers have adopted capping off reimbursement as their primary strategy in health-care cost reduction. Thus the $12 aspirin on your hospital bill does not result in your hospital seeing $12 in revenue. It simply means that your hospital has to bill $12 for that aspirin if it is ever to net the $1.50 needed to meet the costs of providing it. All patients must be well-informed consumers before they enter a hospital if we are ever to see improvement in our health-care financial systems.

Chris Carlson

San Diego

Katrina Wheeler [the chief financial officer at Satilla Regional Medical Center] poses a question in this article that is emblematic of the issues in the health care debate: "When you go to...the vet, you know you have to pay. If you go to the hospital, why should it be different?" My answer: We value human life differently than we value animal life. We need to understand that the value we place on human life makes many of our "free market" analogies irrelevant.

Screen name: Fred Harde

Ironic how the advocates of freeloading now write, and read, BusinessWeek.

Screen name: Andrew

I found it a funny coincidence that your Cover Story on the pain of the uninsured ran in the same issue as your article about the possibility of juggling more than one career ("Reinventing yourself," In Depth, Dec. 3). The idea of working within a "portfolio" of careers is a great one, especially for older baby boomers seeking flexibility. The problem: finding health insurance.

Randall Hansen

DeLand, FLA.

Many hospitals charge uninsured patients significantly more for the same services they provide at lower cost to those who are insured. These hospitals may be compounding the problem by grossly inflating medical bills for the uninsured—charges that they then turn over for collection.

Screen name: Eugene Collins

How Ad Agencies Are Getting It Wrong

Most advertising people are messengers who are clueless about marketing ("Struggles of a mad man," In Depth, Dec. 3). The Big Idea is not about labels, slogans, and buzz words, but about delivering solutions that fix real problems.

Thus the best advertiser is not the one who understands the brand but the one who understands the buyer's needs and behaviors. Advertising agencies not only don't get it, they are going in the wrong direction.

Dennis Wong

Westport, Conn.

In putting talent into silos—telling certain people they are "creatives" and then telling others they are "media"—advertising agency leaders have shot themselves in the foot.

These days, if a client wants a digital component to an ad campaign, a digital expert has to come in. If a client wants a promotional component, a promotional expert has to be called in. The end result is frustration all around.

Many small agencies thrive because they avoid this siloing. Another problem facing the industry: the sparse spending on research and development. No industry spends less on R&D. Even "New Media" agencies in the digital arena spend little money to understand how their products work.

Moreover, the industrywide standard billing practice of basing the fee structures on the man-hours involved has further commoditized talent. Only ad shop Crispin Porter [& Bogusky] has had the guts to say that it doesn't sell hours, it sells talent.

The solutions to the growing irrelevance of the ad industry are obvious, but few seem to have the courage to take the first step.

Marcelo Salup

Coral Gables, FlA.

The Falling Greenback Is a Self-Inflicted Wound'

If the Bush Administration can impose sanctions on Iran in an attempt to disrupt its economy, then Iranian President [Mahmoud] Ahmadinejad is entitled to speak negatively about U.S. currency ("Bad-mouthing the dollar," The Business Week, Dec. 3). The falling greenback is a self-inflicted wound caused by President Bush's idiotic notion that the country could afford both a major war and a major tax cut simultaneously. With so-called ally Kuwait switching away from the dollar, it won't be long before other countries begin doing so—regardless of what Ahmadinejad and Venezuela's Hugo Chávez may have to say on the subject.

Chandran Cheriyan

Saratoga, Calif.

Candidate-Speak: What the Interviews Overlooked

It's a shame that none of the Presidential contenders who were interviewed in "The candidates on innovation: What it is and what they'll do" (In Depth, Nov. 26) talked about conservation initiatives. Mandating lower heating and higher cooling settings in government buildings would give the private sector the cover it needs to adjust its thermostats accordingly. In addition, a yearly fee on inefficient vehicles paid to the states when licenses are renewed would accomplish much of the work of a gas tax and move America to more fuel-efficient transportation.

Bruce Wilds

Fort Wayne, IND.

Why did you interview just the "leading" candidates? I'm sure Senator Joseph Biden (D-Del.) would have had a point of view on this issue. If he doesn't manage to get press coverage, then how does he become a "leading" candidate? It seems only fair to include all those in the race.

Screen name: Tom Clark

John Thain: A Good Catch, or More of the Same?

Repeated references to corporate culture in "He fixed the NYSE. Can he fix Merrill?" (News, Nov. 26) make one wonder if some would like to see [under new CEO John Thain] a return to the starched-collar, blue-blood mentality. The interests of the privileged were protected while the company languished and other more agile and globally minded firms set the standard of performance. [Former Merrill Lynch (MER) CEO E. Stanley] O'Neal was not part of that blue-blood culture, and because he was willing to serve as a change agent, Merrill achieved a position of leadership that few others can match.

Robert Daniels

Sutter Creek, Calif.

Mr. Thain sounds like the breath of fresh air that Merrill needs! O'Neal did not bother to understand the culture or the employees.... The great leaders were people like David Komansky, Daniel Tully, and William Schreyer, who made it a pleasure to come to work.

Screen name: A.D.

As a Merrill Lynch shareholder, I think John Thain, former chief of the New York Stock Exchange Euronext (NYX), is a tremendous catch. He has expertise in the areas in which Merrill has stumbled. And he knows how to get things done.

People are missing something important: Thain looked at Merrill's CDO [collateralized debt obligation] exposure, expressed comfort with it, and was willing to take the job with a substantial amount of his compensation riding on getting the stock back up. As a shareholder, I'm taking comfort in all of that.

Screen name: Street Orphan

Dear HR: Happy Holidays, from the Whole Family

"You've got dependents? Prove it" (Personal Business, Nov. 26), points out that some companies have been asking employees for proof that their spouses and children qualify for medical benefits.

I just added the head of human resources of the Fortune 50 company I work for to my holiday card list so he can see my dependents for himself.

Screen name: HoHoHo

The DVR Defense: I Want My Shows on the Hour

As I read "I want my iTV" (Cover Story, Nov.19), I thought about the latest network TV strategy against digital video recorders. Several prime-time shows end from one to seven minutes after the hour. This curbs the ability to record two shows after the hour.

My answer is to contact the advertisers on these shows and let them know I will not buy their products.

John Hewett

Petersburg, PA.


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