Clinton Health Care Plan
* Thank you for your editorial on the Clinton health reform plan (Feb. 3) which is generally right on the mark. Doctors, individually, and collectively through the American Medical Assn., agree with The Times that this enormously complex piece of legislation (unfortunately and inexplicably developed in secrecy) while admirable in stated goals, does require major modifications if these goals are to be achieved.
The bill as it stands, Clinton’s rhetoric notwithstanding, would require extensive cost controls imposed by government. As Alain Enthoven and virtually all economists have pointed out, cost controls in any sector of economics simply don’t work.
Further technological advancement would be subject to a government review board and not to market forces. Advances in medical care could be impeded.
This bill threatens the malpractice reforms enacted in this state and could drive up medical costs. Since we have costs contained in this state by managed care, the result could be ruinous with severely impeded access.
Finally you laud Insurance Commissioner John Garamendi’s plan and with this we respectfully disagree. You have previously credited Garamendi with being a prime mover behind the Clinton plan. Garamendi favors a single-payer system. A single-payer system, if government, is socialism and, if private, is monopoly. History teaches us that no matter how good they sound, neither works. Nor for that matter will the Clinton approach.
BENJAMIN SHWACHMAN MD
President, L.A. County Medical Assn.
* Re your editorial: CalPERS does not control costs. It shifts them. At our local hospitals, CalPERS Blue Shield pays a per diem rate of between $830 and $950. A three-day hysterectomy stay would be approximately $2,500-$2,900. An indemnity-insured or cash-paying patient would pay between $7,000 and $9,000 for the exact same services.
Given such disparity in prices, not only does CalPERS not pay its own way, it does not contribute to the financing of welfare or charity cases.
It is agreements such as CalPERS that drive indemnity plans out of the marketplace, and shift the costs to those who often can least afford it--the cash-paying patient.
NANETTE WUCHENICH MD
Redlands
* Your editorial discussed Clinton’s health plan. In this as well as all other media presentations, a concern is always raised about another governmental bureaucracy to be created. No one in the media mentions the massive bureaucracy that is encountered in dealing with insurance companies.
Insurance companies, as are all big businesses, are interested in one primary individual--the stockholder. Clinton’s plan is also interested in one individual, but that one is the person who needs health care now and can’t get it.
HARRY SHRAGG MD
Los Angeles
* Let me talk about real gouging that takes place in the medical insurance field by large insurance companies.
I was paying $307 per month for medical insurance as an individual. I was advised that due to inflation, rising health costs, and that many insurance companies no longer will cover this type of insurance, my policy unchanged in any way will now cost $466 per month. I believe if my math is correct, that is a 52% increase per month. I know from The Times, many hospitals and doctors are struggling to survive financially, but I have not heard of any insurance companies going out of business.
PETER WRIGHT
Studio City
* The Times correctly notes that Clinton’s health plan will shut down private medical practice (Commentary, Feb. 2). The Clintons would outlaw the purchase of medical care directly from a doctor. The Clinton plan would close doctor’s offices by the thousands.
This deprives Americans of their freedom to choose their own private doctor. When the few remaining doctors are herded into corporate or government-run HMOs, their new allegiance is to their paymaster, not their patient.
To preserve private practice, and the quality it embodies, the citizen’s constitutional right to buy care must remain the bedrock of any plan. This Congress should develop job-portable, tax-free medical savings accounts. These permit the consumer to buy care directly without the intervention of government bureaucrats, or insurance company rationing.
CHRISTOPHER LYON MD
Steering Committee, Americans for
Free Choice in Medicine, Newport Beach