As a geriatrician with decades of experience caring for older adults with multiple chronic conditions, I was troubled by the March 28 online Health article “Why millions of seniors have suddenly lost health care coverage.”
In my practice, I regularly sit with patients much like Anthony J. Petchkis from rural New Hampshire, who suddenly lost his Medicare Advantage coverage. I work with artists, retirees and neighbors managing heart disease, diabetes, cancer, arthritis and multiple daily medications on very limited incomes.
Medicare Advantage plans attracted millions with generous benefits, but their retreat when profits tighten reveals a fundamental flaw: Private insurers are not required to provide year-to-year stability, which is especially dangerous in rural areas with high-need patients.
Policymakers should act to protect continuity of care, strengthen support for supplemental coverage in traditional Medicare, and ensure rural communities are not left behind. Elders deserve reliable and compassionate coverage.
Raya Elfadel Kheirbek, Baltimore
The writer is division head of gerontology, geriatrics and palliative medicine at the University of Maryland’s School of Medicine.
The March 28 online Health article highlighted one of the ways private health insurers let us down: They withdraw from markets where profit objectives are not being met. Patients often must find a new doctor or have their treatments interrupted or denied.
In Maine, where I live, Northern Light Health, a nonprofit conglomerate of hospitals and other providers, recently withdrew from Humana’s Medicare Advantage network, citing “delayed and denied payments for medically necessary care.”
Unlike traditional Medicare, Medicare Advantage plans require prior authorization for many tests, medicines and procedures, placing an onerous administrative burden on clinicians, which exacerbates the workforce shortage and can lead to delays in diagnosis and treatment.
Publicly funded health coverage would eliminate the inefficient process of routing public funds through private insurers with Medicare Advantage, where 12 to 18 percent is lost to administrative overhead and profit, compared with 1 percent spent on overhead in traditional Medicare.
Best of all, Medicare’s overriding mission is not to maximize profits but to promote the general welfare of Americans.
Michael P. Bacon, Westbrook, Maine
Rural patients deserve human doctors
The March 29 Business article “Can $50 billion and AI make rural America healthy?” correctly pointed out that there are gaps in rural health care, including workforce shortages, chronic underfunding and declining reimbursement.
But AI cannot set a fracture, perform a complex cancer surgery, manage a trauma or navigate the nuance of an elderly patient with multiple comorbidities. Medicine is not merely data processing; it involves judgment, context and human connection. As a physician, surgeon, educator and researcher who uses AI often and focuses on disparities in access to care, I must emphatically state that the comments of the health secretary and the administrator of the Centers for Medicare and Medicaid Services do not reflect a real innovation. It is a convenient deflection from the harder, costlier work of rebuilding a fragile health care system. No algorithm can replace the absence of a physician in a rural emergency room or a nurse at the bedside.
Technology can act as a support, but we must invest in people, physicians, nurses and sustainable infrastructure to improve health care. Rural communities deserve the same standard of care we expect for ourselves: accessible, accountable and human.
Patricio M. Polanco, Dallas
The writer, a gastrointestinal surgical oncologist, is a professor of surgery and director of robotic surgery training at the University of Texas Southwestern Medical Center.
AI policy is already outdated
Brandon N. Owens and Morgan Bazilian’s March 27 op-ed, “AI’s unquenchable thirst goes beyond electricity,” rightly flagged water as an overlooked factor in data center growth. But the piece described an industry that is already moving past the problem it identifies.
I have spent more than two decades in thermal engineering, and my team has built the cooling infrastructure behind six of the top 10 supercomputers in the world. The evaporative systems the authors describe are real, and water conservation should always be top of mind. But a different approach to cooling advanced AI servers and data centers has already been adopted at scale: closed-loop direct liquid cooling that brings fluid directly to individual chips, recirculates it and doesn’t require the use of cooling towers.
Direct liquid cooling is more efficient than traditional air cooling and which can significantly reduce overall data center energy consumption. That matters because electricity generation, not the data center itself, is typically the largest source of its total water footprint.
The technology to build data centers that use less water and operate more effectively already exists. The risk is not that data centers will drain the water supply. It is that public debate, and the regulation that follows, will be shaped by how facilities used to operate rather than how they operate today. That gap between perception and engineering reality must close to ensure policy reflects the pace of innovation.
Rich Whitmore, Buffalo
The writer is president and CEO of Motivair by Schneider Electric.
The wrong Rx for drug prices
Regarding the March 23 online Health Brief, “White House pitches pharma on pricing draft”:
The administration’s effort to codify “most favored nation” (MFN) drug pricing is the wrong approach if America wants to maintain its biopharmaceutical leadership.
MFN pricing ignores the real problems in the system and won’t lower prices for patients. For example, patients abroad wait, on average, nearly three years longer for new treatments than patients in the United States do, according to PhRMA’s analysis. Adopting MFN price controls risks bringing access delays home.
America’s biopharmaceutical sector supports millions of high-wage jobs and is a leader in global medical innovation. That reflects sustained investment and policies that reward risk-taking and discovery. MFN price controls threaten to undermine the ecosystem that has made the U.S. the global leader in developing new cures.
Early signs from the Inflation Reduction Act, the first attempt at price controls, are clear: Small-molecule investment is down by 70 percent, and the monthly average number of post-approval clinical trials for cancer has fallen by 40 percent. Doubling down with price controls would only make it worse.
Lori M. Reilly, Washington
The writer is chief operating officer of PhRMA.
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