Doctors and Managed Care

In the extract from his letter to his patients (“Voices,” Dec. 27), Dr. Peter Waldstein makes some valid points about the problems associated with HMOs, PPOs and avaricious insurance companies. Certainly, the inadequacies of these agencies, and their quest for profits over quality medical care, have resulted in declining health delivery for many Americans.

But one must not ignore the point Waldstein makes several times: He doesn’t make as much money as he used to. It is precisely because of excessive fees by physicians, directly and indirectly through ancillary services like excessive lab tests from which they profited handsomely, that the need for managed care has become so crucial. If a few Americans have seen a decline in their medical care due to the problems Waldstein criticizes, far more of us have had no choice but to settle for managed care plans because we could no longer afford the kind of medical practice he prefers.

The problem of quality health delivery for all Americans is a complex one, and the solution appears to be still beyond us. But the quest for large profits--by physicians, by insurers and by the managed care plans themselves--has been and is the greatest barrier to any such solution.

JOHN M. ALLSWANG

Los Angeles

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Thank you, Dr. Waldstein! Sometimes I think we, as clients or patients, are going crazy trying to “manage” our medical needs under managed care systems. It was interesting to learn that physicians also are feeling “mega-managed.” However, I wish we consumers had the option to “decide to discontinue participation in (two) insurance companies.”

It is very disheartening to watch my caring, knowledgeable physician double-check what kind of insurance I have before she prescribes further tests, etc. I always ask her, “If I were your mother, what would you prescribe?” That takes care of that!

CECILE MAURICE

Seal Beach