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Can Use 2 Systems for Electronic Mail

March 03, 1985

The otherwise excellent article, "Electronic Mail: A Revolutionary Courier Aims to Become Routine" (Feb. 24), did contain one error. The article stated it is not possible for a subscriber to one service to send mail to a subscriber on another service.

Since I am sending this letter via MCI and The Times is receiving it on Western Union, this statement was obviously untrue. Yes, it can be done in the other direction (Western Union to MCI) too.

JULES T. WILLIAMS

Silverado, Calif.

Although originating at a computer terminal, the letter reached The Times via a standard telex printer. However, officials at MCI Mail, like those at other major electronic mail services, say their subscribers soon will be able to send computer-to-computer messages easily across subscription boundaries--possibly within six months. The MCI Mail letter (below) also originated at a computer terminal, but was delivered to The Times by Purolator Courier. --Editor

In light of recent U.S. Postal Service rate increases, it is just a question of time before the cost of a stamp becomes more expensive than sending an instant (electronic) message.

BILL STERN

MCI Mail, Washington

Key Role in Health-Care Costs

"A stronger 'marriage' of the hospital and medical staffs," may well be, "essential for the survival of both," as suggested by Stuart E. Marsee, chairman of South Bay Hospital board of trustees, Redondo Beach (Letters, Feb. 24). However, if the goal is the survival of the patient or consumer of medical care, then what is needed is a better understanding of the three supports of the health-care industry, the consumer, the provider and the institution where they interact.

Just like a tripod, if even just one of the three supports is not strong or well-reinforced, then all three will fall.

With understanding by all three, new concepts may be developed that can either reduce or more appropriately assign the costs of health care for an aging population. Institutional health care, which is the single largest contributor to health-care costs, probably 80% or so of the total, is comprised of a triad of therapeutics, diagnostics and bed-and-board--or hotel--services. A new conceptualization of this last of the triad by the consumer, provider and institution of health care could radically reduce and more appropriately assign its financial burden.

Why, indeed, do ambulating post-operative patients need to have very expensive room service with meals at bedside when they could go to a cafeteria for their meals and benefit by the exercise?

Do the bed linens and towels need changing on a daily basis for all patients? Is that what people generally do at home? Is the hospital to be considered a hotel in the luxury class or rather a place to restore one to good health?

Who should bear the burden for very expensive health care required because of the voluntary abuse of the body by some? Should those who choose to smoke and thereby get lung cancer or those who abuse alcohol and get liver disease, or those who engage in dangerous sports and suffer major trauma have the medical costs of the care be shared by those who do not abuse tobacco or alcohol or do not engage in high-risk sports?

Is it reasonable for our society to expend 20% of the gross national product on leisure-time activities and then complain of the 10% to 11% of the GNP expended on health care? Without good health there's no time for the fun of leisure-time activities.

It is time for the consumer of health care to shoulder his fair share of the responsibility with respect to health care and not have the health-care provider feel all the guilt of escalating health costs that are inevitable as the population ages and the technology advances. All of this could be reduced by consumers staying healthy and thus preventing disease instead of doing the opposite and then complaining about the costs of correcting what they did to themselves.

The institutions where consumers and providers of health care meet could well lead the way by being innovative and supportive of such changes in the concepts and perceptions of health-care delivery, using all the creative tools of business management at their disposal.

SYLVAIN FRIBOURG, M.D.

Woodland Hills

Plan for a Healthier America

Your in-depth article, "Medicine Takes on New Look" (Feb. 10), concerned itself with the current problems and future plans of the medical-industrial complex (insurance companies, drug companies, doctors and hospitals).

It was quite revealing, and serves as confirmation that the members of the medical-industrial complex, as they function now, are not to be entrusted with the public's health care, for we are only a commodity to them. Their concerns are not for the quality, accessibility and affordability of health care; their concerns are for the retention of the good economic health of their practices.

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