Physician Fees and Health Costs

William True’s scathing and simplistic attack on physicians “For a Fee, Our Health Is at Risk,” (Opinion, Dec. 10) is wrong on four counts. First, it makes a sweeping indictment of all physicians’ behavior, attributing it to self-interest. On behalf of my many colleagues who teach without pay, who answer emergency room calls, often rendering uncompensated care every day and night of the year, I take very deep offense.

Second, the article attributes “the runaway inflation in health costs” to the traditional private practice fee-for-service medical care system. The truth is much more complicated. Nearly 80% of every health dollar is consumed in non-physician expenditures; for example drug costs, hospital expenditures and administrative overhead. The vast majority of the increase in the cost of health care is due to general inflation, non-physician medical inflation (hospitals, drugs and supplies), and increasing numbers of “catastrophic” cases including AIDS, trauma, transplants and neonatal intensive care.

Third, the article suggests that private medicine is somehow responsible for the 37 million uninsured individuals in the United States. (including 5 million in California). Actually, the numbers of uninsured have increased dramatically in the past 10 years for three reasons. (1) The Reagan Administration so greatly reduced Medicaid eligibility that currently only one-half of those with incomes below the poverty level are eligible. (2) California removed a large number of medically indigent adults from Medi-Cal and transferred the responsibility for their care to the counties. (3) Employers in California are not sufficiently inclined to provide health insurance for their employees.

Organized medicine is seeking to correct this through legislation and perhaps by initiative.

DAVID CHERNOF, M.D.

President-elect

L.A. County Medical Assn.