The letter objecting to HMOs is one of the more transparently self-serving missives yet appearing in your pages. If fee-for-service physicians feel threatened by HMO competition, it is not with "the loss of (their) freedom to practice quality medicine," but with the loss of their freedom to charge what they please, no matter what, in the expectation that insurance carriers will pay off. Fee-for-service physicians have engendered HMO competition through sheer greed.
My group insurance permits me to choose my own physician for whom I have waited for up to three hours for minor problems that could easily have been handled by a physician's assistant certified at one-fifth the amount charged to my insurance carrier. And I pay myself, of course, the astronomical prescription prices enriching our rip-off pharmaceutical companies.
My husband's insurance, conversely, provides HMO care. When he contracted a severe case of valley fever last year, the HMO provided immediate diagnosis and referred him to a specialist--which any HMO will do when necessary. HMOs keep a rein on outside charges, but a good number of specialists seem to be willing to provide quality care at reasonable prices.
Until 40 or 50 years ago, doctors really knew their patients, charged moderate fees, and were willing to settle for the fairly comfortable life style afforded to any trained professional. Somehow, through the agency perhaps of the powerful American Medical Assn., they transformed themselves into minor deities who frequently believe that no charge is sufficient for their miraculous services.
LOIS E. CHANEY