Costs, Benefits of Managed Care

* Many California employers are able to provide their employees with quality health care coverage only because managed care has made health care affordable. Your own Times poll found that approximately nine out of 10 Californians who use managed care rate their health care as excellent or good.

It was disappointing, however, that “The Health Care Revolution” (series, Aug. 27-31) focused on the small minority of consumers who are dissatisfied with their care and completely omitted the positive effects of managed care. Managed-care plans emphasize preventive medicine for good reason--early diagnosis saves lives. In 1994, the American Journal of Public Health reported that HMO enrollees were diagnosed at considerably earlier stages for four types of cancer and women are more likely to obtain mammograms, Pap smears and other lifesaving treatments.

It was the employer community that took the reins in driving the creation of managed-care plans. The price stability that managed care brings to small business has made it possible for millions of Californians to afford insurance they would otherwise be unable to receive. This is an accomplishment that should be praised.

ALLAN ZAREMBERG, Chairman

Californians for Quality Patient Care

Sacramento

* The recent California recession caused thousands of people to lose their jobs, to learn new trades and start new careers and sometimes move out of state. Why should doctors be immune to economic realities? “Some Doctors Head to Idaho, a State Without Managed Care” and “Doctors’ Authority, Pay Dwindle Under HMOs” (Aug. 29) exemplify this stark reality.

For years the medical community complained that too few people were able to secure health insurance. The employer community got the message and devised a plan called managed health care which would offer the best quality health care at a price that both employees and employers could afford. The result, as The Times notes, is that HMOs now serve more than 12 million people. California has taken the lead while health care reform on the national level flounders.

We’ve all heard the stories of the doctors who have scalped people for years, in many cases performing unnecessary procedures just to make the extra bucks off patients. Now that there is actually a method by which the average employee can afford health care, the docs are losing their authority and some of their luxuries. As you note, they no longer can take home $400,000 a year or drive around in a $70,000 Mercedes. Welcome to the real world.

RON SELLERS

Tustin

* One of the biggest changes threatening consumer safety in a managed care setting is the restructuring of the work and jobs of millions of nurses, technicians, aides and other front-line care givers who monitor patients’ vital signs, administer their treatment plans and bear the hour-by-hour responsibility for their well-being.

To cut costs, administrators are laying off health care workers in droves and heaping extraordinary burdens on those who remain. Apparently believing they can break up the process of patient care into discrete tasks and then assign them without regard for education, licensing or experience, these administrators are implementing untested “assembly-line” work redesign experiments without any evidence that they are safe for patients.

We are calling on policy-makers and legislators to guarantee legally enforceable rights for health care consumers, and to adopt regulations that measure and enforce safe staffing levels and quality care. They should also work to require full disclosure of such by health care providers to protect licensing and credentialing standards from attempts to weaken them by health care employers, and to stop the de-skilling, marginalization and pauperization of the health care work force.

We’d like to see the creation of a national health-care restructuring task force and the forging of an alliance of labor, community, government and industry groups that will develop a workable plan for the way health care should be delivered in this country.

JOHN J. SWEENEY, President

Service Employees International Union

Washington