March 08, 2009

Regulating fertility harms patient care

In "Limiting reproduction" (Commentary, Feb. 25), Adam Pertman and Naomi Cahn make a case for government regulation of assisted reproductive techniques, including laws governing such clinical decisions as the number of embryos transferred to a woman and age limits for reproductive treatments.

The authors cite the Evan B. Donaldson Adoption Institute's report comparing assisted reproductive technology to adoption and suggest that "the legal and regulatory framework for adoption provides a model" for assisted reproduction.

However, reproductive treatment differs from adoption in a number of ways. Perhaps the most important of these is that it requires the clinical input of experienced medical professionals to achieve the best outcomes.

Government regulation and laws governing the number of embryos allowed for transfer to an individual patient or placing age limits on patients who may be allowed to have access to reproductive technology limit this critical input.

Best clinical practices and outcomes depend on the judgment of expert medical practitioners.

Limiting the role of the experience and knowledge of the physician in these decisions is not the way to provide the best care for patients.

Dr. Katherine Miller Bass, Towson

The writer is a fertility specialist.

Health care crisis only getting worse

According to a study released in late February by the Institute of Medicine on the consequences of not having health insurance, the bad situation in U.S. health care has gotten worse.

The number of people getting health insurance through their jobs has continued to decline, the cost of insurance has risen and the number of uninsured Americans has grown.

The report also confirms what we see every day in Maryland: People without health insurance do not get the care they need. They must gamble every day that they won't get sick or injured.

The IOM report finds there is no change in sight for these trends unless action is taken by the president and Congress on coverage and costs.

With more than 775,000 people in Maryland going without health coverage, the report's findings underscore the dire need for the president and Congress to heed the advice of the IOM and act immediately to ensure that all individuals have health insurance.

Suzanne R. Gilbert, Baltimore

The writer is community outreach director for the Maryland Citizens Health Initiative Education Fund Inc.

Longer loans help owners handle debt

The letter criticizing extending mortgages to 50 years or longer makes the valid point that such loans increase a borrower's long-term debt but fails to consider the length of time most homeowners keep a mortgage ("Longer mortgages only add to debt," March 3).

It's highly unusual for a homeowner to keep a mortgage for 30 years. The average time a mortgage is held is around seven to nine years.

Extending the repayment period would achieve the desired effect of reducing the monthly mortgage payment. Wouldn't it make sense to be making smaller payments on a longer-term loan when the chances of staying in a house for 30 years are small?

And from the point of view of the lending institution, I'd rather own a long-term 5 percent loan than have a bankruptcy judge cram down a mortgage payment.

Richard T. Webb, Hunt Valley

The writer is president and CEO of Atlantic Financial Federal Credit Union.

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