My thanks to S. Terry Canale, MD, for the great job on AAOS Now. This is an outstanding publication. Your balanced presentation of the issues is a consistent feature of this work.

Kevin G. Shea, MD
Boise, Idaho

I would like to applaud the AAOS Now for the article by Peter Mandell, MD [“AAOS Board takes professional compliance actions,” August 2008]. This is a great step forward in preventing bad lawsuits and misleading testimony against orthopaedic surgeons.

I was very happy to see physicians’ names published who have not met the standards of professionalism on expert witness testimony and received suspension because of poor testimony. This will make all orthopaedic surgeons think twice about how they testify against their fellow orthopaedic surgeons and is a huge step forward. Keep up the good work, Dr. Mandell and AAOS Now.

Mark D. Shaieb, MD
Honolulu, Hawaii

I just looked at the August AAOS Now, and I cannot, for the life of me, see how you can possibly characterize Tucker Carlson as a conservative when his history and the statements he’s made to the Academy are so very liberal. I might add that his very liberality is what marked the end of his MSNBC show.

This country is more or less evenly divided at the moment and AAOS Now ought not to stick its finger into these boiling waters.

Gene K. Bruce, MD
San Mateo, Calif.

I don’t see how this [article on Tucker Carlson] has anything to do with orthopaedic surgery. Am I missing something?

Amy W. Black, MD
Sacramento, Calif.

“Ahead of the Curve” is around the bend
I read the “Ahead of the Curve” article on Medicaid by the Washington Health Policy Fellows in the June edition of AAOS Now. … The fact is that Medicaid is a huge social and financial failure. When talking about cost containment, one would think of efficiency and a good outcome. In [Medicaid], cost containment is code for paying nothing to the physicians that provide the care.

The graph implies that total spending went down in the last few years; a careful read reveals the rate of growth slowed while total spending escalated [and is] predicted to double in the next 10 years.

The authors report that “children account for nearly half of those covered by Medicaid, but only benefit from 19 percent of Medicaid dollars” as if this is some type of revelation or advantage. This is in keeping with most insurance risk pools (children tend to be healthy and use few resources). The true danger is that these “children” are in this entitlement program for life, and quickly bring in their next generation. …

[S]tates [are] shamelessly advertising and tirelessly trying to increase the eligibility of children, elderly, disabled, pregnant, nursing home residents, people with HIV/AIDS, the poor, the near poor, families with modest (?) incomes. Does it ever end?

Most orthopaedic surgeons cannot afford to see and attend Medicaid patients. Medicaid is spiraling out of control; a fully funded failure whose progress and success will imply failure of orthopaedic success, progress, and excellence. Our new gold standard in science is outcome results; where are the facts to support these opinions?

Douglas G. Wright, MD
Bel Air, Md.

The Washington Health Policy Fellows respond: The “Ahead of the Curve” series is designed to highlight various important healthcare issues, to generate discussion and thought, and to provide some perspective on these issues during this presidential election year. The struggle to find an answer is, in part, what the presidential campaign is all about. Medicaid rules and regulations are the result of a combined effort between the federal government and individual state governments. Although the facts are referenced, the conclusions drawn are grounded, at some level, in some subjectivity. Therefore, different surgeons may have different experiences with the system. As Dr. Wright notes, the costs associated with Medicaid programs are an issue not only for the nation, but also for orthopaedic surgeons and the patients who need their care. The upcoming election may have ramifications on this program due to the federal impact on Medicaid.