Alain Enthoven and Sara Singer's commentary "Let's Try Aspirin Before We Amputate" (Sept. 19) continues to propagate the myth that the U.S. health care system is based upon a "free market." A free market implies that the consumer has a choice. Our current health care system offers few choices, particularly in the midst of a life-threatening emergency. Even for non-emergencies, the consumer is restricted by the employer-dictated health plan and by not knowing enough about the medical options available, the physicians' or hospitals' qualifications, and their fee schedules. Even employers have very little choice when selecting a managed care plan for their employees. And, even more important, reports on the quality of the various managed care plans are simply not available.
The authors warn that any "anti-managed care" provisions passed by Congress could increase the cost of health care by up to 30%. But right now, managed care companies are spending 20% to 30% of our premiums in administration and profits. What is the use of managed care companies providing "efficient" medical care if all the money they save goes into their pockets as administrative costs, profits and bonuses for CEOs?
If the free-market system was applicable to medical care, we should have had the best medical care system in the world by now, since we have had "free market" for the past 30 years. What we have is the most expensive medical care in the world and the system people like the least.
GEORGE BIXLER MD
* It is ironic that Enthoven and Singer should write "government-run health care is likely to be bureaucratic, wasteful and unable to control costs." It is our current insurance company-dominated system, with its huge waste, bureaucracy and escalating costs that created our national health care crisis. To leave it under insurance company control is ridiculous.
Despite skepticism over government involvement in anything, its operation of Medicare and Social Security has demonstrated far greater administrative efficiency than that of the health insurance industry. Also, the single-payer systems in Canada, Australia and many other countries have much lower operating costs than our system.
* After reading "Cheaper, Better Health Plan for Federal Employees" (Sept. 21), I have arrived at an elegant and complete, if not altogether serious, answer to the national problem.
Simply make everyone who votes an employee of the federal government because he or she is performing a government service. Non-citizens would be excluded because they can't vote, and many, many more citizens would vote.