Managed Care, Single-Payer
* For once I agree with Newt Gingrich (March 29). A thorough investigation of the voracious managed-care industry needs to be performed, one which will hopefully show that this “revolution” in health care delivery has everything to do with profits and nothing to do with providing health care to people who need it. Indeed, the very term Health Maintenance Organization was coined in the early 1970s by Paul Ellwood, who later convened the Jackson Hole Group that spearheaded Clinton’s insurance company-dominated “managed competition” program. Ellwood personally sold President Nixon on the HMO concept as a counter to Ted Kennedy’s single-payer national-insurance proposal.
Numerous studies have shown that HMOs rake off up to 30% of premiums on profits, advertising, executive salaries and corporate overhead. This is no better than the traditional indemnity approach. HMOs are certainly more profitable for their wealthy investors and executives, but they cost the same, deny us any choice of provider, and signal the end of doctors as independent professionals.
RANDALL SMITH
Del Mar
* Re “Rx for Doctors: a Price List,” Commentary, March 27:
Lloyd Krieger’s solution to the rising costs of medical care is a good first step on the road to medical cost control. Until medical care is treated like a business, which it really is, costs will keep rising.
Here are reasons medical care is not being run as a business: 1) Hospitals overcharge based on the fact that they must cover the costs of caring for patients who cannot pay. 2) Doctors do not consider costs due to their primary interest in the patient’s medical care. 3) Patients demand unnecessary tests because they believe insurance, and not they, will have to pay for them. 4) Insurance companies do not provide any medical care and further complicate all the above because their primary role is to make money for their stockholders.
BILL PATTERSON
Tustin
* Nicholas V. Seidita’s letter on March 24 advocates what amounts to a single-payer system for health care. On Jan. 7, 1995, my father died, killed by the Canadian single-payer system. He was in very good health, mentally quick as a whip, with no major heart, kidney, lung or other diseases. On Jan. 5, in Toronto, he fainted, signaling a partial tear of the major artery near his heart. Surgery was his only hope for survival; he was anxious and ready. Despite calls by his heart specialist, no surgeon was willing to even examine him.
You may ask why? He was 87 and people over 80 are excluded from such life-saving care because it costs too much. Since there are no private alternatives in Canada, he was excluded from even the possibility of paying for life-saving care from his own pocket. I confirmed with experts in the field that such surgery would have been done anywhere in the United States, regardless of age.
MICHAEL LITTNER MD
Sepulveda
