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National Health Insurance

October 20, 1987

Health care planners and economists continue their brainstorming to discover creative ways to pay for health care services. The solution depends on reducing the charges. Hospitals and doctors consistently escalate their charges beyond the rates of inflation and, as long as they continue to be reimbursed, this practice will not stop.

Private health insurance companies provide coverage for more than 90% of all employed persons and allow for the payment of doctors on a "usual and customary" basis. But how do they decide what is usual and customary? Computerized data collection sources track all doctors' charges and these data form the basis for insurance payments. As the doctors charge more, the insurance companies raise their premiums to maintain their margin of profit. There is no cost containment.

And what about hospitals that consume 40% or more of every health care dollar? Insurance company policies uniformly allow hospitals to charge just about anything they wish for so-called ancillary services. These ancillary services include drugs, laboratory and X-ray tests and a host of supply services. The mark-up may be as great as 1000% for any given item.

Moreover, there is no constraint on the part of the hospital to prove that the quantity of provided services was medically justified.

As a physician who has practiced medicine for more than 25 years and who has been a student of the health care system in this country for an additional 15 years, I am convinced that one way out is the establishment of a national health insurance program. The time has come when the American electorate must demand that their representatives pass such legislation. Until that time comes all of us will continue to pay a greater part of every earned dollar without any guarantee that our access to quality health care services is maintained.

RAYMOND D. GOODMAN M.D.

Beverly Hills

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