Letters: Health, transportation, environment

Since when did our personal doctors become the insurance company's lie detectors? Apparently Blue Cross has never read the Hippocratic Oath, a physician's lifetime oath to, among other things, "respect the privacy of my patients, for their problems are not disclosed to me that the world may know" (this is from the version written in 1964 by Louis Lasagna, dean of the School of Medicine at Tufts University).

- Laura Daetz, Meadow Vista

Making case for universal care

The Feb. 12 "Letter jolts Blue Cross physicians" story makes a vivid argument for universal health care. Do we want insurers to ask physicians to rat on patients who fail to disclose previous conditions that would disqualify them from getting medical attention?

Hooray for Dr. Richard Frankenstein, the outraged head of the California Medical Association.

- David B. Jacobson, El Dorado Hills

Why health care costs soar

Re "The death of health care reform," Daniel Weintraub, Feb. 10: No meaningful health care reform can take place without reining in our runaway health care inflation (insurance premium costs are rising at least two times the rate of overall inflation in the economy).

Medicare sets the template for compensation of doctors and hospitals; private insurance largely follows suit (but charges far more overhead than Medicare). Medicare overcompensates procedures (such as heart stent placement, colonoscopy, MRIs and many surgeries) while undercompensating the face-to-face care of patients by both primary care doctors and specialists. Doctors and hospitals have incentives to overuse expensive procedures and technology. Skyrocketing costs result.

In her recent book "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer," Shannon Brownlee carefully examines the evidence that Americans are not better off for all the high-tech expenditure. In fact, the United States has the worst public health statistics of the major industrialized nations, despite spending approximately 50 percent more per person.

Out of the approximately $2.1 trillion we will spend this year on health care, as much as $700 billion may be superfluous. That would buy all the uninsured and underinsured high-quality health care, with lots left over to reduce the costs for the rest of us.

- Stan Gambrill, MD, Davis

You don't have to be fat like that

Re "Is it your fate to be fat?" Feb. 12: Don't be misled by the claim that weight is a "strongly inherited" trait. If that were true, how could the proportion of Americans who are obese have doubled since 1980?

Our genes haven't changed. What's different today is the abundance of calorie-rich foods and the dearth of opportunities for physical activity in our daily lives.

Yes, it is true that some people are more prone to develop obesity than others living in the same environments. And, yes, it is very difficult for most people to lose weight and keep it off. But the fact that weight often comes back after dieting should not be taken as evidence of genetic determinism. It merely testifies to the powerful influence of the environment in which we live on the accumulation of body fat throughout the population.

We can turn around the obesity epidemic through collective action to create healthier environments. This would include making affordable, healthy foods and snacks more readily available in local markets, requiring restaurants to provide nutritional information on menus, making communities more walkable by adding sidewalks and bike paths, supporting more physical education in schools and promoting more weight control programs in workplaces.

Fatness isn't a matter of fate.

- Jason Eberhart-Phillips, MD, Placerville

El Dorado County Health Officer

Taxing gas for transit is illogical

Re "Time to consider a new way to pay for transit," editorial, Feb. 12: The logic in favor of using gas taxes to bolster public transit is derived from the same school of logic that advocates increasing cigarette taxes to pay for children's smoking prevention programs.

In the latter example, the programs need roughly the same number of children or adults to take up smoking as quit or die each year. Otherwise, less tax money is collected and the health programs lose funding. So in a sense, their continued financial survival is predicated on the failure of the program.

The same problem presents itself when using the gas tax to fund public transit. If transit is successful, it becomes deprived of funds as fewer people are paying the gas tax. So again, in order to ensure their financial viability, transit agencies would need to ensure that more gallons of gasoline are consumed by drivers.