President’s Health Plan
* Your Opinion pieces (Sept. 26) on President Clinton’s health plan raised many objections without offering alternatives or openly defending the status quo.
Based on my long years of experience in private practice, including managed care/competition, I believe the Clinton plan has an excellent chance of working well for America. Its political logic is impeccable. It does not create large bureaucracies. It sets the rules of the game, and market forces produce the results. It preserves what is best in our system, and corrects, insofar as is possible, the defects. And it makes both providers and insurers confront the perverse incentives that have created the present crisis.
That the health-care system needs reform no knowledgeable person can deny.
SIDNEY I. SIEGEL MD
West Covina
* The notion that screening for diseases before they cause symptoms can lead to over-diagnosis and over-treatment (Commentary, Sept. 29) and therefore should be restricted or eliminated is a compelling metaphor for the difference between the way doctors who are desk-bound bureaucrats and clinicians in the trenches view patients.
To the author in the Department of Veterans Affairs a patient is evidently a statistic and represents a potential budget deficit. To the doctor at the bedside or in the office, the patient represents a father and a husband or a wife and a mother for whom we must make every effort to detect life-threatening illness early because often that is the only way we can cure.
Medicine is still as much art as science or we could all be patients of Robo-doc. Obviously, diagnostic tests are not always perfect; of course, there are some false positives. However, I think often of a 45-year-old man whose life was saved because despite his youth and all statistical odds he did have prostate cancer, which was found in time, and remember sadly a 29-year-old mother who died after she was denied early testing for a breast lump because she was “far too young to have cancer.”
ARTHUR D. SILK MD
Board of Directors
Orange County Medical Assn.
* Much has been reported these last few weeks concerning the American health system. As President Clinton stated, we have the finest health care in the world. The system is not perfect and has flaws that must be rectified. Every physician I know thinks that some form of change is needed to make health-care delivery more equitable for all. The blame for rising health-care costs has been painted over a broad canvas including physicians, insurance and pharmaceutical companies, bureaucracy and lawyers.
We have the finest health-care system because we have the most technologically advanced care in the world. This technology is extremely expensive and in some case it is not efficacious. It is easy to understand why the majority of one’s health costs for a lifetime are spent in the last six months of life. Ten years ago people who would have died are now kept alive in intensive-care units utilizing space-age technology. Unfortunately a good percentage of these same people are not leaving the hospital alive. They live in a twilight zone for two to three weeks before dying. We as a nation are going to have to make key and difficult decisions. Can we afford to continue pouring our limited resources into a never-ending vortex of advanced medical technology? Only after this issue is fully addressed can we hope to have any meaningful reform of our current condition.
STEVEN HESLOV MD
Newport Beach
