Doctors should get final word on care

Michael Vitez's story "Inpatient or outpatient? The battle to control costs" (Sunday) opened my eyes, and hopefully the eyes of many others, to the issues of hospitals and insurance companies determining how a patient is treated. I am shocked that an insurance standard, a "little book ... called InterQual," cannot be overridden by the attending physician. As Dr. Steve Fisher said, "I guess I thought that we were still allowed to override the damn thing. It shouldn't be gospel. It should be a suggestion." It is very clear that Dr. Kevin Zakrzewski is frustrated because insurance companies do not want "more clinical information" or "physician judgment." Instead, he says, "I had to provide information that met InterQual."

The attending physician should have the final word on inpatient or outpatient care. Medical costs must be controlled, but that should not be a factor in overriding an attending doctor's prescribed health-care plan for a patient.

Joe Gable

Warwick

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Good riddance to Arlen Specter

I was amused to read the coverage of U.S. Sen. Arlen Specter's retirement saga ("Service is his legacy," Sunday). It brought a single tear to my eye.

I can succinctly characterize Specter's career in these words: opportunist and Anita Hill. For the second heroic gesture, we are stuck with Supreme Court Justice Clarence Thomas for decades. All else is superfluous.

Specter never knew when it was time to exit gracefully, destroying the Democratic Party's chances of electing U.S. Rep. Joe Sestak to the Senate this year. Of course, part of that problem was Specter never knew which party he wanted to belong to. Good riddance.

Stephen Gring

Ocean City

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Federal power and its limits

It's clear that many of those railing against Judge Henry Hudson's ruling on the health-insurance mandate do not understand our federal system of government.

It is irrelevant whether or not the mandate is a good idea. This is a question of federal power and its limits. The federal government has never before had such power (auto insurance requirements are state laws), and it is a broad stretch to consider the purchases of individuals as falling under the constitutional provision for federal oversight over interstate commerce.

If the mandate is ultimately upheld, it would set a precedent with significant consequences. For example, the federal government could require that we all buy our quota of fruits and vegetables and implement limits on purchasing red meat. It's certainly a good idea from a public-health perspective, but do we want a government with that kind of power?

Tom McCarthy

Wilmington

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Where is outrage over DRPA hikes?

Where is the outrage ("DRPA's board should be replaced," Thursday)? The commuters will have to bear yet another toll increase, along with Patco train fares increasing, while the same people are still in control of the Delaware River Port Authority. The same executives and board members that gave the store away to projects totally unrelated to DRPA business are asking for increases again, so they can now do what they are supposed to have been doing: maintain and repair bridges and rail lines. Why weren't these people ousted and replaced with competent personnel? Why are Govs. Christie and Rendell ignoring this situation?

Bob Direso

Philadelphia

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Media can help with bipartisanship

The major thing Americans want is effective governance, regardless of political parties. This will require bipartisanship and inclusion from both parties. We are seeing some signs of this with legislation recently enacted - the tax cut issue for one, where President Obama personally emphasized the importance of compromise ("Obama hails 'productive' Hill session," Thursday).

However, the media (mainly TV, but also some print) seems to view everything as a scorecard item. Obama won this vs. the Republicans won that. Nothing will polarize our legislators faster than that approach to reporting the news.

Why not report on these issues by emphasizing the "give and take" and how the government is truly succeeding from a bipartisan approach? Encourage that activity in Washington instead of keeping score.

Dave Gilbert

Kennett Square

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Sales by museums pose financial risks

Most museums need the option of deleting as well as acquiring collections. However, too often the sale of art, historic artifacts, and scientific specimens to meet capital and operating costs reflects a failure of institutional governance.

Perhaps the financially precarious Atwater Kent should be forced into "receivership" and placed under the oversight of the state attorney general ("Atwater Kent reopening in spring with sharper focus," Dec. 21). The bankrupt (pun intended) board could be eliminated and new members asked to do what's fiscally needed to create a nationally stellar museum about an extraordinary city.

Until then, unless financial reports clearly show that money realized from selling collections is indeed restricted to the acquisition of new collections or the direct conservation of collections, it will evaporate into general operations, debt payments, and capital projects, as boards ignore their fiduciary duties.

Steven Miller

Morristown