Have Insurers Entered a Social Contract or a Business One?

I was appalled to see the comment by Dr. Steve Raffin, a medical director of Foundation Health Care, concerning the “covenant” between an insurer and a “covered life”--which in the past was referred to as a patient (“Losing Patience,” July 9).

The only covenant involved here is between the patient and doctor to attempt to restore health and do no harm. The insurance policy, on the other hand, is a business contract, usually between an employer and the most successful salesperson to ply his or her proposal.

There is often a great discrepancy between the programs described in the glossy sales pamphlet presented to the employer and employee, and the actual services that will be covered or excluded by the contracted health care provider. Despite the careful perusal of these documents by the “covered life,” medical policies are usually not interpretable by the lay person.

Hence, the advent of frequent calls to the “subscriber advocate,” who then gets the thankless job of explaining to the enrollee what is or is not covered in their plan.

Are “medical directors” so divorced from patient care in their roles as medical economists and “gatekeepers” that they truly feel an economic objective to return the highest dividend to a stockholder is equated with the “covenant” they accepted with the oath of Hippocrates?

MARY SPAHR

Los Angeles

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So. An outer ear is unnecessary? Repairing a cleft palate or other deformity is cosmetic surgery?

Who are these barbaric, despicable people making such mean-spirited decisions? Obviously, they are immune from having such events occur in their lives or the lives of their loved ones, or they are so enriched from profits made by such hateful cost-cutting for their patients that they can pay for trips to their own plastic surgeons.

CHRISTINA WALDECK

Torrance