Healthcare, bathtubs, AI, and more.
No Free Lunch
“LDI and American Healthcare” by Mary Ann Meyers [Jul|Aug 2026] mentioned that Medicare Advantage (MA) plans cost the federal government 14 percent more per person than does traditional Medicare. The result is unexpected, the article implies, as the creators of MA plans believed that competition among the private companies should instead drive down costs. My personal experience, as a nearly 65-year-old enrolling now in Medicare, leaves me entirely unsurprised.
I quickly discovered that beneath all of the choices and details to consider is a fundamental trade-off between choice and cost. Traditional Medicare offers more choice among providers but at a greater expense for the enrollee. For thrifty people who perceive themselves healthy, people like me, low-cost MA plans naturally appeal. For persons with preexisting conditions and with doctors they know and trust, traditional Medicare appeals. Consequently, we Medicare enrollees self-partition—or cherry pick—ourselves, in doing so undermining the risk pooling essential to insurance. People respond to trade-offs, even those unanticipated.
So, of course, the government overpays for MA plans because that’s where the healthy, low-intensity users of healthcare are! One policy response might be to document this phenomenon and use it as a reason to reduce reimbursement to companies offering MA plans. Of course, that would likely raise the premium and cut the benefits of the Humana HMO MA plan I just enrolled in. Alas, as economists like to say, there ain’t no such thing as a free lunch.
Paul B. Laub Gr’95, Albuquerque, NM
Insurance Doesn’t Provide Healthcare
Mary Ann Meyers’ article “LDI and American Healthcare” [Jul|Aug 2026] thoughtfully explores many of the challenges facing American healthcare. As a 1982 graduate of the University of Pennsylvania School of Dental Medicine and a pediatric dentist who has practiced for more than four decades, I would suggest that one essential component of healthcare reform deserves greater attention: the long-term economic sustainability of the healthcare professionals and institutions upon which every insurance program ultimately depends.
Much of the national conversation centers on expanding coverage, controlling costs, improving quality, and redesigning payment systems. These are all worthwhile goals. Yet insurance, whether public or private, does not itself provide healthcare. Healthcare is delivered by physicians, dentists, nurses, hospitals, and countless other professionals who must remain both willing and financially able to care for patients. Without a sustainable healthcare workforce, even the best-designed insurance system cannot fulfill its promise.
That raises what I believe is a fundamental policy question. Before government establishes payment levels under Medicaid and Medicare, shouldn’t it first determine the efficient cost of providing high-quality care and establish a transparent, evidence-based methodology for keeping payment aligned with those costs over time? Every healthcare practice and institution faces unavoidable expenses—professional staff, employee benefits, facilities, equipment, technology, supplies, liability insurance, regulatory compliance, and continual reinvestment to maintain quality and safety. Inflation affects each of these costs, making periodic reassessment essential.
Dentistry provides one illustration of this broader issue. According to the American Dental Association Health Policy Institute, Medicaid dental reimbursement nationally averages approximately 39 percent of dentists’ usual fees and about 67 percent of average private insurance reimbursement. In Texas, Medicaid dental reimbursement has remained essentially unchanged for approximately 18 years—and counting—despite continual increases in virtually every cost of delivering care. Although these figures pertain specifically to dentistry, the broader principle applies across healthcare: payment systems that fail to keep pace with the efficient cost of providing care ultimately threaten the workforce upon which patient access depends.
This also raises an important question of fairness. Government routinely recognizes inflation by adjusting compensation or benefits for many public employees and beneficiaries. Healthcare professionals delivering services through public programs perform an essential public function, yet there is often no comparable mechanism to ensure that payment keeps pace with rising costs. Over time, inflation does not disappear; it is absorbed by the professionals and institutions responsible for providing care.
Cost containment is an essential goal of healthcare policy. The question is not whether costs should be controlled, but who bears the burden when payment no longer reflects the efficient cost of providing care. When reimbursement persistently falls behind inflation, healthcare professionals and institutions increasingly absorb that burden. Eventually, practices reduce participation, postpone investments in staff and technology, retire early, or leave public programs altogether. Patients ultimately experience the consequences through diminished access and fewer choices.
As Penn continues to shape the national conversation on healthcare policy, I hope it will also help lead a discussion about a question that receives far less attention than coverage or cost: What constitutes economically sustainable reimbursement? Coverage, access, quality, and affordability are all indispensable goals, but each ultimately depends upon a healthcare workforce that remains economically viable.
Insurance coverage is a promise of care. That promise can only be fulfilled if the professionals and institutions responsible for delivering healthcare remain willing—and economically able—to do so.
George M. Angelos D’82, Harlingen, TX
Not Sure About the Bathtub!
Always, I enjoy the Gazette. The recent issue celebrates the 30th anniversary of the Kelly Writers House [“The 30-Year Squat,” Jul|Aug 2026].
When I was a student, this was the chaplain’s house. I do not remember if Stanley Johnson was the chaplain during my years. During at least 1930–31, it was the house of Sigma Zeta fraternity. My father, William F. Steinkamp W’31, and his fraternity brother and roommate, G. Fesler Edwards W’31, lived there. One of them was president, so they occupied the front room, second floor. Not sure about the bathtub! They would be very proud of this current use, as I am.
Richard B. Steinkamp W’63, Little Rock, AR
What AI Can Do for Radiology
In “Premature Autopsy” [“Expert Opinion,” Jul|Aug 2026], Dr. Robert Wachter C’79 M’83 tells us that radiologists are still needed. No argument about that. But what he misses is that when AI improves, the machines will not only obviate humans making the complex visual judgments; but also, they will dramatically increase the medical value of scans.
There is a long history of technological advances surpassing human judgment. Thermometers and scales replaced sensitive hands, sonar replaced water dowsers, blood tests and smog tests replaced visual inspection. Tennis linespersons and baseball umpires are on the verge of extinction; fingerprint analysts may be next. Foretelling the future is often hazardous, because conditions change; but Dr. Wachter appears to sense the inevitability of radiology joining the list. This is obviously not a good thing for students pursuing the field, but in the long term it’s probably a benefit to humanity.
Expertise can be inadequate for two distinct reasons. One is human frailty. Those certified as experts via education and/or experience may not live up to the label. Human performance also varies with intrapersonal factors such as current health status, fatigue, and distraction. AI will not. Given a set of input information, AI will always return the same output. It will be consistent, and it will discriminate to the extent of its programming and its sensory capabilities. These are the AI advantages of which Dr. Wachter is already aware.
The other reason expertise can be inadequate is systemic. The right answers are unknown. The gold standards are often tarnished. The history of medicine is replete with examples of diagnoses and treatments that were ineffective, even harmful. AI’s big potential is to increase validity. The goal is to make radiological instruments and judgments more accurate, more likely to produce correct answers. As of now, a radiologist makes a determination, a clinician makes a treatment decision about what should be done given that determination, and a patient outcome occurs. What does the radiologist learn from that outcome? I hope I’m wrong but, I fear, very little. At best, some feedback occurs; but even then, few other radiologists share it.
AI offers the potential for massive data sets to be scrutinized, with the determination-decision-outcome chain allowing the field to advance. Human analysts can’t process this much information unaided. By the way, treatment decisions, which evolve as new interventions become available, will also be assisted by AI. Machines will be learning how to read scans with an eye toward improving results. How can society incentivize AI developers to cooperate with physicians and go in that direction?
David J. Weiss, C’66, Brea, CA
Many Need Help “Getting Up”
I appreciated your coverage of Commencement [“Gazetteer,” Jul|Aug 2026]. Regarding the keynote address given by Michael Beschloss—in which he referred to FDR asking his son to dust him off after he fell and then implored all of us to dust ourselves off when we fall and then get right back up—I would maintain that it is not always than simple. Many times, people are traumatized and need help “getting up.” This can take the form of professional assistance, one’s social network, or through other means. While I agree with the spirit of Beschloss’s remarks, I thought it important to add this qualifier.
Harry Toder C’71, University City, MO
Watch Your Language
In Julia M. Klein’s review of Five Bullets [“Arts,” Jul|Aug 2026], she states that Bernhard Goetz fired five bullets, “injuring all four boys.” According to Wikipedia, three of the four were 19 years old, and the other was 18—that is, not boys, but adults. Did Klein consider them “boys” because of race? And/or, by labeling the four as children, was she trying to drum up more sympathy for them than she thought some readers might have based on the unvarnished facts of this complex, tragic case?
Please, watch your language.
Vanda Krefft C’76 ASC’01, Santa Monica, CA
This letter sent the story’s editor to his desktop copy of Webster’s Dictionary, in which the second definition of boy is “a young man who lacks maturity, judgement, etc.” That seems consistent with the writer’s usage.—Ed.
Haunting Experience
The article “100 Years of Powerful Pipes” [“Gazetteer,” Jul|Aug 2026] brought back fond memories of the Curtis Organ, including seeing the original film Phantom of the Opera with Lon Chaney Sr. at Irvine Auditorium on Halloween 1973 or 1974. It was a silent movie with the musical accompaniment of the amazing organ. When you sat down, you could hear the air whirring in the windchest and the vibration of the huge pipes, which seemed to be under the floor. Together, it was a haunting experience of the senses without equal.
Ed Dosik W’77, Potomac, MD
Winning Argument
As a retired appellate lawyer (but not before the US Supreme Court), I so enjoyed Dennis Drabelle’s recounting of Bill Eggers’ argument before the Supreme Court in “The Pride of Lombard Street” [“Alumni Voices,” Jul|Aug 2026]. That experience was made all the more poignant by the stories of Bill’s and friends’ law school high jinx. It brought me back to so many similar such experiences in my ’70s Penn undergrad days. Thank you for resurrecting those days with your story, Dennis!
Andy Cohn C’74, Philadelphia
Needless Injection of Race
This is sent to respond to a hateful letter in the Jul|Aug 2026 edition of the Gazette. Try as I might not to respond—suspecting that the vast majority of Penn alumni recognize, and dismiss, demonstrations of ignorance when they see them—I can’t help myself. Perhaps failure to respond to ignorance simply serves to sustain it.
The letter writer and her husband are apparently “disgusted” by the fact that the character draped in red and blue on the cover of the May|Jun Gazette focusing on our nation’s 250th anniversary was, let’s be honest, not white. Such a selection means, apparently, that the University is too liberal, and the letter writer can no longer be proud of her alma mater.
After considering many potential responses, I choose just this: I recall seeing the cover when it arrived—thought the largely red and blue outfit/hat were well done, offset nicely by the white shirt showing underneath. As for the character wearing the outfit—didn’t really notice. Why on earth would I? It’s a random character that presumably represents Penn in some way—white, Black, red, yellow—what’s the diff?
For those to whom the color selected for a fictional representative of our University brings disgust and loss of pride, I share words to which Benjamin Franklin once affixed his signature: “All men are created equal.”
For those who felt as I did on reading the letter writer’s needless injection of race into a simple Gazette cover picture—Hail Pennsylvania!
Matthew Arbit C’83, Highland Park, IL
Passion to Play
I thoroughly enjoyed the article entitled “100 Years of Powerful Pipes,” noting the hundredth anniversary of the magnificent Curtis organ in Irvine Auditorium [“Gazetteer,” Jul|Aug 2026]. I had the time of my life as a medical student in the 1960s playing the organ at Irvine, which I did almost daily. I must confess that, as a result, I missed some of my dermatology classes, which is one reason I chose to pursue a career in neuroradiology!
Professor Wachter’s article on AI and radiology [“Expert Opinion”] gave an excellent account of the complexities of the cognitive process required to be an expert radiologist. AI was only in its most elemental stage when I was working, and in my chosen field, applications were not readily available.
As I am now retired for five years, this newfound freedom to use my time as I wish has allowed me to return to my passion to play the organ. That wish has been fulfilled as I am the resident organist at the Hanover Theatre in Worcester, Massachusetts. I am privileged to play what is the largest theatrical organ in Massachusetts.
Jonathan Kleefield M’70, Newton Center, MA
Cover-to-Cover—and More
On a recent family visit in Colorado with some free time, I finished reading Barons of the Sea by Steven Ujifusa GFA’05, a Penn grad [“Arts,” Mar|Apr 2013]. I also read my May|Jun 2026 edition of The Pennsylvania Gazette. In my 59 years since graduating, I have rarely made time to do a cover-to-cover read.
What made this edition so interesting is the historical coverage involving my adopted hometown of Philadelphia [“Semiquincentennial Sampler”]. After 47 years, I can almost call myself a Philadelphian. I knew that Ben Franklin was credited as the father of Penn but never knew that Penn started as the College of Philadelphia.
Having provided legal services in real estate matters, including representing the City of Philadelphia, I was fascinated to read “What Lies Beneath” [“Arts”]. As a classical music aficionado, I can’t believe I have missed attending a performance by Mimi Stillman’s chamber music group, Dolce Suono [“Alumni Profiles”]. I am anxious to read Shaun Ossei-Owusu’s book Law on Trial to find how my legal training failed to include a greater emphasis on the morality of legal practice [“Witness and Judge”]. Finally, I noted the letter to the editor by the iconic Dan Rottenberg extolling how his experience as a walk-on football player at Penn helped shape his career as a journalist and editor.
Now I must catch up and read the article about Zeke Hernandez [“The Newcomer Dividend,” Jul|Aug 2024], whose book The Truth About Immigration, I also read.
Ralph S. Pinkus C’67, Philadelphia
Don’t Miss the Broader Context
I found the article about Shaun Ossei-Owusu [“Witness and Judge,” May|Jun 2026] a fascinating analysis of how lawyers narrow their focus as a consequence of their practice and the problem their client presents to them. Social implications are then set aside, the broader context missed.
There is for me a striking parallel to my own work as an EMT in my small community in Upstate New York, and as an instructor in emergency medical services. Just as attorneys focus on their client’s immediate problem, the EMT/paramedic focuses on what is wrong with their patient right now. “You called 911 because you are having difficulty breathing.” Similarly, the cardiologist sees a diseased heart, the endocrinologist a thyroid imbalance. When I taught new EMTs, I would frequently remind them, “You are treating a person, not a problem. Take a moment to look around, to see what is going on in the home, what are the factors contributing to the problem.”
Similarly, as Ossei-Owusu proposes, we will all benefit if the attorney looks beyond what the case presents to the root causes and societal context.
Steven Gayle C’71, Gilbertsville, NY
