Re "Rx for Universal Care," editorial, Dec. 29: Although every caring person agrees that the debate on universal care needs to be moved into the mainstream arena, considerable confusion remains. Should we build on the current system of employer-sponsored plans and public programs or should we replace them with a single-payer system?
Although continuing to use private plans would perpetuate the tremendous administrative excesses that waste resources that should be directed to patient care, fewer public tax dollars would be required to expand coverage to everyone. But most individuals and businesses should be concerned not only about their tax expenditures for health care; they should be concerned about their total health-care expenditures, both public and private. An increase in tax funding should not be objectionable when it is offset by an even greater reduction in private health-care spending.
In a universal system, rationing is determined primarily by the capacity of the system. A system that reduces administrative waste increases its capacity. We may be so averse to the words "tax" and "government rationing" that we may want to continue with a system that wastes more funds and results in greater rationing. But then again, maybe we're ready to agree that rational policy should prevail over rhetoric.
Don McCanne MD
President, Physicians fora National Health Program
San Juan Capistrano
Your editorial has it exactly backward. The plan discussed would cost more money than a single-payer system. It would increase administrative costs and add to the increasing complexity and inconsistencies of the present system. The math is simple: Administrative costs take 3% of the Medicare single-payer health-care dollar; they take 20% to 30% of the health-care dollars of the current multipayer system. The single-payer administrative savings can provide broader coverage for all at much less cost. Any needed increase in taxes would probably not exceed money we are already paying as part of many other insurance coverages: personal auto, homeowners liability, workers compensation, etc.
Your dismissal of a single-payer system on grounds that it has failed to gain needed support is irresponsible. If The Times threw its support behind a single-payer system your reason for rejecting it would immediately become untrue.
George E. Delury
Your editorial quotes the head of Blue Shield of California as advocating a mandatory medical insurance system requiring all but the smallest employers to either provide it or contribute to a state insurance pool. There already is a universal medical program being planned in the form of a bill to be carried by state Sen. Sheila Kuehl (D-Santa Monica). This would cover all Californians and be funded by the money already being spent in this state for medical care and health insurance.
The medical insurance industry is opposed to this legislation because it would eliminate all insurance providers that do not provide direct services. The plan would use existing doctors, hospitals, laboratories and other licensed providers of medical services. What would be eliminated are the marketing, competition, redundant administrations, stockholder profits, multiple requirements and billing programs and other costs generated by the for-profit medical insurance system. Except for the relatively small cost of a state oversight and billing system, the money would be spent on patient care and everyone would have medical coverage.
Melvin H. Kirschner MD
For universal care, the state would tax every employee for health care but pay the health benefits for 35 million residents, even if they didn't work or were in the U.S. illegally. But what happens when the state can't pay its bills? Look at the problems with the state Medi-Cal now. The governor is going to make drastic cuts and simultaneously ask for tax increases to cover a $34-billion deficit.
Talk about "rationing" -- the elderly will not be treated or will die waiting years to be treated for a serious ailment.
Can President Bush really think that "frivolous lawsuits" are responsible for the huge increases in medical costs (Dec. 29)? The reason medical costs keep increasing is twofold. First, we as a society agreed that for-profit health care corporations are acceptable. Second, any medical intervention regardless of the prospective outcome or the condition of the patient is undertaken. "Frivolous lawsuits" has to be about reason No. 999 for the increases I have seen in my health coverage.