Uwe Reinhardt's Jan. 17 commentary, "The Unmanaging of Health-Care Costs," is, of course, all true and well stated, but in my opinion a negative and pessimistic piece at a time when health advocates should be upbeat and optimistic about our efforts to bring the U.S. into the 21st century with a single-payer, universal health-care system. Just as the media appear to be finally waking up to the fact that the system is in crisis, just when health care is on politicians' radar screens and will be a pivotal issue in the next presidential election, I think Reinhardt missed an opportunity -- blew it big-time -- to hammer home the point: If it doesn't work for everyone, it doesn't work for anyone.
It's time for Americans to realize that health care is a right. It's time to stop needless deaths and suffering by providing access to necessary health-care services for everyone, just as every other industrialized nation does. It's time to curb the profiteers who take billions of health-care dollars as profits and for paperwork, waste and fraud, while 50 million Americans are without coverage and face Third World health care or no care at all. That's what Reinhardt should have written.
Felix A. Schwarz
A reason health-care costs are escalating is because employees no longer want anything resembling medical insurance. They now demand highly subsidized or free medical care, especially those who have children. What do you expect to happen to "insurance" costs when every simple checkup, shot or teeth cleaning is nearly free? We essentially want all the services of socialized medicine, while sticking our heads in the sand about paying the bill.
Reinhardt berates workers for demanding that General Electric keep its health coverage package just the way it is now, instead of increasing it by only "$200 to $400 per employee per year." Left out of the discussion is the number of workers who could be covered by retiring Chief Executive Jack Welch's compensation package alone. How "juvenile" is it to make minor demands on a corporation that has shown it has boatloads of money to lavish on its executives?
Reinhardt's column is an attempt to blame the failure of his theory -- that true competition in the field of health care could keep costs reasonable and allow the continuation of employer-based health insurance -- on the extravagant expectations of individual workers and softhearted benefit managers. This might be true in a truly free market, but medical care is far from a truly free market. When sickness strikes, the individual does not have free choice whether to buy or not.
Also to blame are the HMOs themselves. This is a system where 25% to 30% of the premium dollar goes for administration, marketing and dividends rather than to health care (Kaiser Permanente excluded).
Robert Jaspan MD