But suppose we were told at the box office that we have to pay more for a movie ticket simply because the theater says we can afford to do so. No one in his right mind would feel that is fair. So why should those who are well off have to pay more than their fair share simply because they can afford it? Why should they be penalized for spending their time engaging in productive activities?
It appears that we are attempting to penalize those who have done all the right things that good parents try to teach their children to do: work hard, learn from your mistakes, and become a success. Maybe instead of being jealous and punishing those who are successful, people who want to increase taxes on the wealthy should try to find out what they did to become successful and emulate them.
Peter DiGiuseppe, Philadelphia
Show support for Postal Service
The Postal Service "crisis" is ludicrous ("$5.5 billion default looming for Postal Service," Tuesday). How many other companies are forced to pay for health-care benefits to retirees 75 years in advance? How many workers in this country even get health care when they retire before 65?
When Congress approved the Postal Accountability and Enhancement Act of 2006, it stabbed the Postal Service in the back. It has been generating what the postmaster general calls "a crisis of confidence" and causing financial problems for the Postal Service by delaying the postal-overhaul bill. Since the Postal Service is an independent agency, it should be allowed to be independent.
People who use the post office for some things, such as packages and prescriptions, should use it for everything. I pay my bills by mail to keep postal workers and bill processing people in a job. I don't mind writing checks and stamping envelopes in order to keep people working.
Sue Park, Philadelphia, firstname.lastname@example.org
Debt and the doctor shortage
As a physician who trains medical students and residents, I read the article "Doctor shortage to worsen" (Sunday) with great interest. While it is true that students and residents are picking fields other than primary care because they are more lucrative, it is often as a result of the staggering financial burden they face when they finish their training.
Many students and residents face debt in the neighborhood of $250,000 to $300,000. Additionally, they have undergone four years of undergraduate training, four years of medical school, and an average of three to five years of postgraduate training. During all this training they continue to accrue debt.
While physicians are blessed with the opportunity to make a salary that is well above that of the general population, today's medical students and residents face thousand of dollars in loan payments per month. They have essentially mortgaged their futures. They simply cannot afford to engage in primary-care areas such as family practice, internal medicine, and pediatrics. Making education more affordable for those who aspire to be physicians is clearly one important component to address the shortage of primary-care providers.
The article also notes that there is a relative dearth of specialists too, and accurately states that there is a shortage of training spots for graduating students and residents.
Our health-care system is like our sickest patients, failing in many ways. Our "doctor shortage" is but one component, and the cure is quite complex.
Stanton Segal, medical director, Aria Hospitals, Philadelphia, email@example.com
Make use of nurse practitioners
As a women's health nurse practitioner, I was disappointed that the article "Doctor shortage to worsen" did not address the use of nurse practitioners as the best solution to the expected shortage of primary-care physicians.
According to the American Academy of Nurse Practitioners, there are about 155,000 nurse practitioners, educated at the master's or doctoral level, in the United States providing care to patients. Nurse practitioners have been care providers since the 1960s, and studies consistently demonstrate that they provide high-quality care through a unique blend of nursing and medical skills — at approximately half the cost of physicians.
Sixteen state boards of nursing allow nurse practitioners to practice without physician supervision, but all work closely with physician colleagues in order to facilitate referrals if physician care is indicated. The Institute of Medicine (2011) report "The Future of Nursing: Leading Change, Advancing Health" supports the idea that nurse practitioners offer an excellent solution to the shortage of primary-care clinicians.
Denise Callahan Long, Mount Laurel