U.S. Rank in Health Care

* Re “Despite Big Spending, U.S. Ranks 37th in Study of Global Health Care,” June 21: What is the big mystery about the World Health Organization report that the U.S. spends more money than any other nation in the world on health care but in terms of the quality of the health system ranks way down in 37th place, a bare two notches above Cuba?

Has everyone forgotten that hundreds of millions of dollars of health-care spending are skimmed off the top every year to pay the exorbitant multimillion-dollar salaries of CEOs of for-profit HMOs?

On a more modest level, I received a bill recently from a Los Angeles area medical laboratory operated by Columbia/HCA--the nation’s biggest hospital chain--for processing a PSA test, a widely used screening for prostate cancer. The charge: $600. Doctors I know say the going rate at many labs is $30-$60. (My PSA test was normal.) On the very day I received that bill, May 19, a front-page story in The Times announced that Columbia/HCA agreed to pay $745 million in civil penalties for systematically defrauding the Medicare program for years by overbilling. Possible criminal charges are still pending.

Is it possible Americans are not getting more of a bang for the big bucks they (and the government) are spending for health care because commercial operators who run much of the health system are in it for the money, while telling doctors how to practice medicine?

SAUL HALPERT

Sherman Oaks

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The news that Cuba ranks 39th (quality index .834) in health care compared with the U.S. at 37th (index .838) should clinch the argument against returning Elian Gonzalez to primitive Cuba but might suggest sending him to Spain, which is seventh (index .972).

JOHN MAYS

Malibu

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Having recently spent a few hours in an Italian hospital I can tell you that while the visit was free, it was worth even less.

RON LUTEY

Camarillo