Flanigan’s Views on Medicare Provoke Strong Objections

James Flanigan’s “Reforms May Be Just the Rx Medicare Needs” (Oct. 15) provides some interesting and important history about Medicare, but his conclusion is wrong, and he omits some significant facts:

1. The Gingrich “reforms” are really a meat-ax attack. The trustees have been reporting for years that changes will have to be made to keep Medicare solvent, so the current “crisis” is strictly political. In their latest report, the trustees recommended cutting only $89 billion instead of the Republicans’$270 billion.

2. Gingrich’s cynical deal with the American Medical Assn. is the height of business as usual, a sellout to one of the biggest lobbying organizations in Washington. In recent years, doctors have not been permitted to bill their patients for more than 15% over the rates determined by Medicare. The deal: The 15% limit will be eliminated and Medicare cuts can be passed through as additional charges to the “beneficiaries.” Even if they have supplementary insurance, the patients will be socked because premiums will have to go up or benefits reduced.

3. Doctors will have the right to set up their own health maintenance organizations. The slippery slope here is that HMOs assume the financial risk of providing the services they promise at the rates they negotiate. If, in the race to be competitive, rates are set too low, the doctors can experience heavy losses. As a result, the physician sponsors might well be influenced by the financial impact of their decisions about patient care instead of making judgments on strictly medical grounds. This common criticism of commercial HMOs would simply become more direct and personal.

These are only a few of the details that we have read about in the press. With limited public hearings and only political posturing in Congress, no one knows what else is buried in the text. We have to rely on your experts and reporters to analyze and let us know what’s really in these measures. With enough public exposure and protest, it may still be possible to stop or fix the more egregious provisions in the GOP plot.

LOUIS GARFIN

Laguna Beach

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As a Medicare recipient and an admirer of James Flanigan, I was sorely disappointed in his column on Medicare. Most often a well-reasoned and illuminative writer, Mr. Flanigan this time clustered such a pastiche of euphemisms and contradictions together that it’s hard to believe he wrote this column.

There are so many examples of these that there isn’t space here to list them all, but some can’t be overlooked. The most egregious is his use of the statement attributed by him to Marc Margulis, an employee of a Los Angeles investment banking firm. Mr. Margulis is to have said that “HMOs . . . are motivated to keep people healthy.” I can only assume Mr. Margulis read this advertising slogan off a billboard outside his office as he talked to Mr. Flanigan on the telephone.

An HMO’s fundamental motivation is to make a profit. Their astonishing success thus far in this respect comes from selecting the healthiest as members, selecting doctors who agree, without regard to either the good or ethical practice of medicine, to provide the cheapest care possible to patients and to accept bonuses for not referring patients to specialists.

If Mr. Flanigan had wanted to verify this, he could have consulted any local physician, therapist or nurse not employed by an HMO (and perhaps some who are). He would not have had to go to a Harvard or Princeton professor to come to his conclusion.

I was glad to see Mr. Flanigan made one astute observation, which is that the trumpeted $270-billion savings is rhetorical and not to be seen in reality.

Ideology is the motivation here. Destroy the American people’s right to manage their own health care. By forcing patients into the control of private insurance companies and unbridling the AMA to charge whatever prices they want for the public’s care, they are writing a prescription for destroying it.

As a matter of fact, the current House and Senate bills attacking Medicare have been assembled in such haste and secrecy that even their sponsors haven’t full knowledge of their contents and consequences. Mr. Flanigan admitted this by implication.

What should have been obvious to him is that what is needed instead is a thorough and deliberative endeavor to reform publicly managed health care. There is no rush necessary for any purpose other than political expediency. Pushing Medicare into an abyss is not a step in the right direction.

ROGER WEST

Seal Beach