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Letters to the Editor

Letters to the Editor

Better Ways to Keep Howard Healthy?

Since I left JHSPH, in 1971, I have worked in the field of social health insurance in about 40 countries. It is not easy to understand why the U.S. has not been able to achieve equity in access to adequate health care for all. “Keeping Howard Healthy” [Summer 2009] was therefore a pleasant surprise. However, I question why such an important initiative, which could be expanded and replicated, is not based on good practice? First, why is the coverage offered on an individual basis, and not on a family basis, to avoid adverse selection, and increase the size of the pool? It is fairly simple to work out premiums for all family members. Second, why is coverage limited to a specific income bracket? The near poor and families with incomes of over US$66,000 may not be able to afford unexpected, expensive but necessary surgery. Third, why limit to six primary health care visits per year? Health insurance is not like purchasing a subscription to a planned series of events; the need for health care is usually unpredictable. In all the social health insurance systems I have been involved in, we scrapped such limitations. Fourth, the provision of pro-bono services by specialists is not an adequate basis for expansion and replication. Neither is free care by hospitals. Why not find a way to include these services?

Aviva Ron, ScD ’70, ScM ’68
Netanya, Israel

Andy Barth, director of Communications for Healthy Howard and Howard County Health Dept., responds: We appreciate the kind words. Dr. Ron would like our efforts at providing care for all to be perfect, and so would we; where we fall short of that standard it is simply due to a lack of funding. Why do we provide six visits to a primary care doctor a year? Since the average American visits his primary care physician 2.3 times a year, we hope and believe six will be adequate. Why rely on pro-bono care in some instances? Because we don’t have resources to pay for all services. Our county and our country have come a long way toward more equitable care this year; we hope constructive critics like Dr. Ron will continue to help us forward.

Proof of Purpose

As a college student myself, I was particularly interested in your article on lowering the drinking age [“Proof,” Summer 2009]. I cannot argue with data, and if studies show that a lower drinking age would only serve to exacerbate a serious problem, then I won’t say it makes sense. However, it is quite apparent that the population is not heeding the laws. I’ve seen many alcohol awareness programs, and they all say the same thing and have the same effect: none. Spending money on helping students find a purpose in their lives, helping them focus their attention, would combat drinking more, as they would be more inclined to pursue tangible goals, rather than party every weekend.

Matt Getz
University of Florida

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