Jube Shiver Jr.'s article (Dec. 26), "Low-Cost Health Groups Distress Physician Critics," should by virtue of its accuracy create distress to all true health-care professionals as well as all others who may be patients.
Fee-for-service physicians are distressed that health-maintenance-organization prepaid physicians may not provide necessary services because of financial considerations. Besides being untrue on the basis of published data, such an allegation can be easily countered by charging that fee-for-service physicians will perform unnecessary services for the same venal motives alleged against prepaid physicians not performing necessary services and which so distress physician critics of HMOs.
Such allegations, besides being untrue, serve no useful purpose, and are contrary to the prime professional goal of physicians to serve their patients first and foremost, and not themselves or their pocketbooks.
Another issue touched upon in the report is the question of rationing medical care. As medical technology advances, and becomes increasingly expensive, the population ages, and as expectations rise, including the expectation that health care is a universal right, shortages of medical care may truly become a reality.
Additionally, it may be necessary to make hard decisions about what is necessary for good health and life, and what is not necessarily essential. There is precedent for these kinds of difficult decisions in the renal dialysis and transplant services. Is the expensive technology of "test-tube" babies one that should be considered a necessity, or not essential? Should society, in the form of government, insurance companies, or other third-party reimbursers, continue to be required to pay for disease and disability that is totally preventable, such as that caused from the uses of tobacco? These issues are equally applicable to fee-for-service physicians and prepaid HMO physicians.
Would these distressed physicians suggest that students are served differently by private school teachers, public school teachers and tutors? Would these distressed physicians suggest that the quality of legal counsel is dependent on whether the attorney is paid on contingency, on a retainer, on a government salary or pro bono publico as a public defender? No, a professional, is a professional, is a professional, and is first and foremost a professional, irrespective of the method or mechanism of compensation, else the professional is not a professional, or at the very least is distressing and distressed.
It would be more pertinent for the physicians in the report who are distressed to address themselves to the issue of maximizing health-care services professionally to their patients rather than worrying about their HMO "competition."
After all, in a free-enterprise system such as ours, those who provide the best services at the best cost should have no cause for concern. The patient, as consumer, will decide whether or not the physicians in the report are rightly, or wrongly, distressed.
SYLVAIN FRIBOURG MD