Can Use 2 Systems for Electronic Mail

The otherwise excellent article, "Electronic Mail: A Revolutionary Courier Aims to Become Routine" (Feb. 24), did contain one error. The article stated it is not possible for a subscriber to one service to send mail to a subscriber on another service.

Since I am sending this letter via MCI and The Times is receiving it on Western Union, this statement was obviously untrue. Yes, it can be done in the other direction (Western Union to MCI) too.

JULES T. WILLIAMS

Silverado, Calif.

Although originating at a computer terminal, the letter reached The Times via a standard telex printer. However, officials at MCI Mail, like those at other major electronic mail services, say their subscribers soon will be able to send computer-to-computer messages easily across subscription boundaries--possibly within six months. The MCI Mail letter (below) also originated at a computer terminal, but was delivered to The Times by Purolator Courier. --Editor

In light of recent U.S. Postal Service rate increases, it is just a question of time before the cost of a stamp becomes more expensive than sending an instant (electronic) message.

BILL STERN

MCI Mail, Washington

Key Role in Health-Care Costs

"A stronger 'marriage' of the hospital and medical staffs," may well be, "essential for the survival of both," as suggested by Stuart E. Marsee, chairman of South Bay Hospital board of trustees, Redondo Beach (Letters, Feb. 24). However, if the goal is the survival of the patient or consumer of medical care, then what is needed is a better understanding of the three supports of the health-care industry, the consumer, the provider and the institution where they interact.

Just like a tripod, if even just one of the three supports is not strong or well-reinforced, then all three will fall.

With understanding by all three, new concepts may be developed that can either reduce or more appropriately assign the costs of health care for an aging population. Institutional health care, which is the single largest contributor to health-care costs, probably 80% or so of the total, is comprised of a triad of therapeutics, diagnostics and bed-and-board--or hotel--services. A new conceptualization of this last of the triad by the consumer, provider and institution of health care could radically reduce and more appropriately assign its financial burden.

Why, indeed, do ambulating post-operative patients need to have very expensive room service with meals at bedside when they could go to a cafeteria for their meals and benefit by the exercise?

Do the bed linens and towels need changing on a daily basis for all patients? Is that what people generally do at home? Is the hospital to be considered a hotel in the luxury class or rather a place to restore one to good health?

Who should bear the burden for very expensive health care required because of the voluntary abuse of the body by some? Should those who choose to smoke and thereby get lung cancer or those who abuse alcohol and get liver disease, or those who engage in dangerous sports and suffer major trauma have the medical costs of the care be shared by those who do not abuse tobacco or alcohol or do not engage in high-risk sports?

Is it reasonable for our society to expend 20% of the gross national product on leisure-time activities and then complain of the 10% to 11% of the GNP expended on health care? Without good health there's no time for the fun of leisure-time activities.

It is time for the consumer of health care to shoulder his fair share of the responsibility with respect to health care and not have the health-care provider feel all the guilt of escalating health costs that are inevitable as the population ages and the technology advances. All of this could be reduced by consumers staying healthy and thus preventing disease instead of doing the opposite and then complaining about the costs of correcting what they did to themselves.

The institutions where consumers and providers of health care meet could well lead the way by being innovative and supportive of such changes in the concepts and perceptions of health-care delivery, using all the creative tools of business management at their disposal.

SYLVAIN FRIBOURG, M.D.

Woodland Hills

Plan for a Healthier America

Your in-depth article, "Medicine Takes on New Look" (Feb. 10), concerned itself with the current problems and future plans of the medical-industrial complex (insurance companies, drug companies, doctors and hospitals).

It was quite revealing, and serves as confirmation that the members of the medical-industrial complex, as they function now, are not to be entrusted with the public's health care, for we are only a commodity to them. Their concerns are not for the quality, accessibility and affordability of health care; their concerns are for the retention of the good economic health of their practices.

The entire medical-industrial complex has been responsible for a 900% increase in health-care costs in the last 20 years with no commensurate increase in the quality of our care. Though the California Medical Assn. approved, as policy, the concept that "it is the basic right of every citizen to have access to adequate medical care and the opportunity to achieve and enjoy good health" the association has all but destroyed that right.

What about the future?: Medicare will go bankrupt within the next six years. Medical benefits will be slashed even further. Insurance premiums will continue to go up. Coverage will go down and health programs for children will be cut back still further as costs continue to climb.

Since the medical-industrial complex helps itself to more and more all the time, with no intervention on the part of the government, we must help ourselves. It is necessary that we replace our current health-care system with a new system that has the following qualities:

Coverage to all people in the United States.

Coverage of every part of our bodies from birth to death.

Every aspect of health care, including preventive, acute and long-term care.

Incentives to assure access to quality health care with built-in cost containment.

Paid for on the basis of the patient's ability to pay.

Federally administered, with provision to phase-in existing health-care systems.

Adequate consumer participation at all levels of policy development.

Development of local consumer-controlled health-care delivery systems.

Provide consumers with the right to choose their own doctors, within or outside the plan.

Authoritative research has shown that such systems are available in every industrialized country in the world, except the United States and the Union of South Africa. In addition, in early 1977, a magnificent bill was brought before Congress detailing and describing the implementation of just such a system. The bill will be reintroduced in this congressional session.

For our group, the die is cast. Our goal is a national health-care plan, and our task is an enormous one for we will be in contention with one of the country's richest and strongest lobbies. It will require the concerted and well-organized efforts of individuals and organizations in the community, on a local and national level.

TRUDY SCHWARTZ

Southern California Coalition for National Health Care Now

Loves Apple's Macintosh

The article "Apple's Computer Will Soon Talk With IBM'S" (Jan. 24) missed the mark entirely. Apple is definitely not "bowing to the inevitable" by announcing a network that will incidentally allow IBM PCs to communicate with Macintoshes and Lisas.

By introducing such a product, Apple is providing businesses that already own IBM micros with the opportunity to upgrade to the Mac without losing their original investment. I say "upgrade" because that is precisely what replacing an IBM PC with a Macintosh is. As an employee of the University of California, I see so many people who come to work one day and find a hulking IBM sitting on their desk, without the slightest idea of how to use it or even what to do with it.

In fact, I'd say that most of them are scared to death of the thing. Many of these people's needs would be more than adequately fulfilled with a Mac, and their productivity would noticeably increase, since it takes less than a day to become familiar with a Mac instead of the weeks of studying IBM manuals. Why do so many companies make money by writing tutorial books and software for the PC, and its related programs? The need obviously exists.

One problem with the Mac is the "Power User." This is the guy whose company buys him a loaded PC/AT with the latest software like Symphony and dBASE III, and then does little more than write memos and file phone numbers with it. Apparently, the Mac is too easy and intuitive for some executives. I guess it just looks a lot more impressive to have a big, ugly complicated system overflowing one's desk than to have a small, friendly Macintosh sitting there. Once products such as Lotus' Jazz becomes available, there won't be any reason not to have a Macintosh. And in the meantime, there are more than 300 applications for the Mac now, to silence those who whine that "It's cute, but it's a toy. . . . "

The software is long in coming because the Mac is not an easy machine to develop applications for. Part of the problem is deciding just what sort of software to write, since the Mac's visual interface opens up a whole new dimension in software design. Some of the first Mac programs were IBM packages that were simply ported over, and they don't run much better on the Mac than they did on the PC.

The upshot of all this is: Give the Mac time. It's only been out a year, and is growing by leaps and bounds. Remember, the PC was in a similar position the same time after it was introduced, and look where it is now. Anything you can do on a PC, you can do faster and more easily on a Mac, and there's a lot that you can't do on a PC that a Mac is capable of.

DAVE BROUDY

Irvine

Letters to the Business Editor should be as brief as possible and are subject to condensation.

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