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LETTER TO THE
EDITOR

September 15, 2022
To the Editor, October Issue 2022

First, The American College of Physicians is to be commended for maintaining its position concerning a single payer system for two
years. Dr. Seidenfeld accurately portrays our healthcare as “broken.”
But it must be recognized that all the defects he accurately notes have been known and identified by the most ethical healthcare econ-
omists in the United States and the remainder of the world for DECADES. The problem is in the United States, due to tremendous pres-
sures and lobbying from all the parts of the system, there is a desire to maintain the status quo. Unfortunately, there are economic gains
provided through that broken system. The question is “How many more decades will it be before the other physicians’ organizations, the
insurance industry, the pharmaceutical companies, the legal profession, the medical equipment manufacturers, etc., etc. will join in to a
plan that benefits our citizens?”
Beyond that, there is an even greater defect in our system. While spending multiple times per person that the other countries of the
world, we end up with the worst statistics of the entire western world.
Why? For years, those benefiting from the status quo have put forth the misinformation that the dichotomy between cost and quality
of care was the unfortunate insufficient level of care provided to the underprivileged. They claimed that an examination of the remainder
of society would demonstrate much better results. It is not and has never been true. The most recent evidence, only the last in a line of re-
search papers revealing the dishonesty in that claim, was revealed in the newest data on maternal deaths. Our maternal death rate was the
only one of the industrialized countries to be rising. Every other country’s rate is falling. Even more horrifying, if all the underprivileged
are taken out of the mix, the maternal death rate for the more affluent Americans is still the worst in the world.
The explanation is very simple. In the U.S. we do so many excessive operations and procedures, deemed unnecessary elsewhere, the
normal rate of complications from these activities raises our complication rate to levels that are unconscionable.
The introduction of a single payer system will cut back on the costs to our healthcare system and provide other advantages. But to com-
pletely correct our broken system we must find a way to limit the abuse to the system caused by the medical community itself. It will prob-
ably be the most difficult challenge we will have to face. It will be a battle between the Hippocratic Oath and greed in a portion of our
medical community.

By Herbert H. Keyser, M.D.

If you would like to send a letter to the editor of San Antonio Medicine magazine, please email editor@bcms.org.

8 SAN ANTONIO MEDICINE • December 2022