State Regulation of Health Care Reform

I would like to thank Glenn Melnick (“Keep Sacramento Out of HMO Reform,” Commentary, Feb. 25) for demonstrating, however inadvertently, why health care must be regulated by government. If we don’t do something in Sacramento, Melnick’s philosophy might prevail to the detriment of all.

The focus of his article is exclusively, completely and unremittingly on cost. The argument is premised on the notion that managed care is a good system because it is a cheap system. This has been at the heart of the massive and growing public discontent with managed care, mostly because it all but ignores the question of quality.

Doctors should not have incentives to skimp on giving patients their time and caring in order to bring costs down.

Some markets should not be built with a bargain basement, and health care is the chief example. Melnick, who teaches not health care but health care finance, joins the thousands of market-trained non-physicians who have invaded the health care system. As long as they continue interfering with doctors doing their job, legislators have to step in.

LIZ FIGUEROA, Chair Assembly Insurance Committee

D-Fremont

* Instead of keeping Sacramento out of HMOs, we need to keep out the health care financial professionals. They make medical decisions without ever seeing the patient, based on cost-effectiveness.

Our daughter, after two major surgeries, was released prematurely each time. The result was that she collapsed, went back to the hospital and has been there since Dec. 26. As a consequence the patient, spouse, children, parents and siblings have suffered beyond belief. This has been a nightmare of major proportions. So much for cost-effective, so-called modern medical care.

DVORAH COLKER

Los Angeles

* Melnick omitted the most important part--the patient. California hasn’t solved “one of our nation’s most pressing social problems.” We have more uninsured people than ever before. California’s managed care isn’t viewed by outsiders as the panacea but as leaner, meaner employer-driven health care with its own host of problems.

Mandates may not be the answer, but there’s an obvious need to get dollars back into patient care. For-profit HMOs transfer health dollars from Main Street to Wall Street. Paying the least in health care premiums eventually means rationing and the least amount of care.

Competition isn’t new to health care. Patients used to have choice of physicians and access to them. Now, patients are no longer in charge. Today, we are seeing that patients will vote for a system not only with their feet but also at the ballot box.

STANLEY C. LOWENBERG MD

President

Orange County Medical Assn.