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I read with interest Dr. Elaine Fox’s two letters [“Do the right thing,” March 13 and “Just a cop-out,” March 20] to The Southampton Press, which dealt with her advocacy of a single-payer healthcare system. I write in support of her position.?The statistics are becoming familiar: We spend more per capita ($7,100 per person) on health care than any advanced country; we experience 18,000 needless deaths due to the lack of health insurance (source: Institute of Medicine); 31 percent of each of our healthcare dollars goes to administrative costs rather than to the actual delivery of health care.?As a former healthcare administrator, I am all too familiar with the money chase that absorbs so much time, staff and energy in any hospital, clinic, or provider’s office in this country. Patient accounting staff is needed to bill and re-bill, call and cajole, submit and resubmit paper or electronic claims to extract monies from the myriad health insurance companies, Medicare and Medicaid, all with different billing rules and coverage plans. ?You might think that only the financial department is involved in this process, but it involves other departments (admitting, medical records, information technology, patient registration, utilization review and others), all spending less time on patient care and more time satisfying the illogical and bureaucratic payment system. (Note: Most hospitals’ financial systems are more technologically advanced than their patient care systems. Why?)?Beyond the immense bureaucratic effort to extract money from insurance companies, hospitals, doctors and other providers grapple with the problem of the underinsured or uninsured. Through the Emergency Medical Treatment and Labor Act (EMTALA), all hospitals must at least screen every patient entering our hospitals’ emergency departments. Who pays for these services? Patients will be billed, but most of these claims make their way to our bad debt accounts (it’s almost as serious as the bad debts on Wall Street). Eventually, hospitals recoup some of this money through the bad debt and charity care funds. (Guess where that money comes from?) ?The inner-city facility where I worked maintained solvency partly because of the $35 million we obtained from New York’s bad debt and charity care pools. ?The system is both irrational and broken. We need an honest debate about healthcare funding. I thank Dr. Fox for her contribution to this debate.?

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