First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.
The story
“Insurance companies like United Healthcare are not the only ones to blame for a broken system,” by Elliott S. Fisher
The response
In U.S. health care, physicians get paid a “negotiated” rate with any of the commercial insurance companies. However, most small-practice physicians can never talk to anyone in these insurance companies and therefore get a base low rate. The cost of operating a small office in most cases is above what is being compensated for a lot of these visits. On the other side, larger corporate- and hospital-owned offices have corporate negotiators with contacts in insurance companies and negotiate contracts, which pay up to 10 times higher for the same service! What does this do? Small physician offices become smaller, cut staff, and soon the physician retires. Does everyone see how long it takes to get a medical appointment? What does this do to the cost of U.S. health care? Only the most expensive and least efficient corporate offices survive. Upside-down capitalism! A simple solution to level the playing field: make the payment rate for any CPT code only vary by 20% for a county.
— Sandeep Gupta
The story
“Pediatrics is becoming medicine’s largest skeleton crew,” by Jared E. Boyce and Faith Crittenden
The response
The majority of children that I serve are Medicaid recipients (more than 90% of my clinic, in fact), and I agree with all of the reasons stated regarding why students do not want to go in to pediatrics. Aside from the lack of reasonable pay, mountains of paperwork, and the revolving door of patients, I think we must also address that oftentimes in rural areas, there is only one pediatrician, and they are responsible for all of the care that a child needs: emotional, behavioral, psychological, and physical. It is a very large burden to carry and sooner or later, we have to lay it down for the sake of our own well-being.
— Dr. Williams
The story
“Mental health apps need a complete redesign,” by Benjamin Kaveladze
The response
This is a brilliant, and welcome, contribution to the field; a focus on user experience, behavioral economics, and ideation on interventions/activities to progress efficacy in those with lived experience is worthwhile and relevant to consider. In addition, it may also be helpful to reimagine the problem for which mental health apps purport to be the solution. For too long, those funding and developing such technologies have limited their thinking to extending forward the in-person clinical models of psychology and psychiatry that have been dominant for the past century, with moderate success. Perhaps by imagining the world as it actually is today and building digital mental health solutions to solve the actual problems of those with lived experience in the real world, coupled with the redesign the author calls for, we could see real improvement, and impact, in this important space.
— Matt Lewis, LLMental
