Health System Reform: Hold On to Your Wallet

"It's the Republicans' Turn to Find a Health-Care Cure" (Dec. 28) omits the biggest immediate threat to the Medicare system: no commitment to our seniors' health care either in Congress or the White House. The Medicare system is only as good as its physicians, yet last Jan. 1, Medicare payments to physicians were cut 5.4%. An additional cut of 4.4% will take place in 2003.

This is occurring while office expenses are rising. The cost of rent, staff salaries, drugs, medical and office equipment as well as what physicians must pay for health, liability and workers' compensation insurance -- all these are going up. The cuts are due to a "flawed formula" for calculating Medicare payments that Bush administration and congressional leaders admit should be changed. But talk by these leaders hasn't fixed the problem, and meanwhile reports abound of seniors forced to seek care in emergency rooms because fewer and fewer physicians can afford to treat them.

As someone who sees the problem firsthand, I am worried about where I will find care when I retire. As someone who talks to physicians daily, I fear many will be forced to stop seeing some of their patients.

Peter M. Warren

Vice Pres., Communication

California Medical Assn.



Though attempts to control outrageous health-care expenditures are clearly laudable, the Republican agenda to create a prescription drug benefit under the aegis of private insurance should give seniors pause. The reason for that concern is that "private insurance" in Republican political-speak is a euphemism for "senior HMO."

The HMO drug formulary approach is cost-driven, not outcome-driven, so this represents another shift of public funds to private coffers. A better approach would be to create a drug benefit under Medicare with formulary choices of medications made by health-economic analyses of evidence-based medicine.

Irving Kent Loh MD

Thousand Oaks


I read your article with interest. Then I grabbed my wallet. Near the end it states, "Supporters believe that [the Breaux-Frist plan's] approach would increase competition and eventually save money."

I guess the key word there is "eventually." I feel like Good Ol' Charlie Brown when Lucy pulls the football away. When Ralphs took over Hughes markets, the CEO went on TV to say that increased buying power would mean lower prices. Not where I shop. Cable deregulation

OK, Republicans. Show us the way. Lead us into a world where all can have health care, in this, the greatest nation on Earth.

Arnie Moore

Sherman Oaks


Somehow I feel less secure about my health-care prospects with the GOP free-market vision of greed mongers like Enron taking care of business.

Paul H. Wangsness


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