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Single-Payer Health Plan

March 15, 1994

* Alain Enthoven and Sara Singer, in their comments on the "One Huge Flaw of Single Payer" (Commentary, March 8) have demonstrated how the intellects of our society can lose all perspective by rigidly adhering to their own ideology and ignoring the real world around them.

They do not realize that there are not two, but three great crises in health care in America: severe impairment of universal access, exploding costs and, now, significant deterioration of the quality system we have enjoyed, produced by the same market forces that they so strongly tout.

The insurance industry and its managed-care subsidiaries, by using market forces, are destroying the quality of our health-care system. Because of competition, they sell their product at discount. They meet all of their overhead expenses. They retain their profit. They then contract with organizations, such as independent practice associations (IPAs), which, in turn, also meet their overhead and retain their profits. The providers, physicians and hospitals, then have additional overhead expenses handling the complicated requirements, such as prior authorization procedures and rigid billing processes. These extraneous middlemen expenses, in their fullest expression, are now consuming 30% of the discounted health-care dollar. This has left us with inadequate funds to provide proper medical care.

The current market-driven insurance system has proven to be far more expensive, and far more evil, than any governmental bureaucracy could ever be.

Any system can mandate universal access. Only a single-payer system, with a budget cap, can control costs, and, yet, maintain a quality health-care system, by directing the funds into patient care, rather than presenting them on a platter to greedy third-party payers.

DON R. McCANNE MD

San Clemente

* A major problem with discussions of the President's health reform program is that most everyone articulate enough to present newsworthy opinions is already covered by some form of health insurance. They do not need the plan for themselves. This means they are talking about getting something for someone else.

No wonder they ask, "Can we afford it?"

What they mean is "Can we afford to spend our money for them?"

Perhaps the attitude should be, "Unless everyone is covered, no one is covered." That would end the discussions and bring action in a hurry.

ROBERT L. PORTER

Anaheim

* I have been listening with great interest to the TV advertising of the insurance industry against the Clinton medical plan. They are obviously spending an enormous amount of money to cover the country the way they are.

The more they spend, the more certain I am that the Clinton medical plan must be wonderful for the consumer!

MORRIS L. SHECHET

Oceanside

* It is richly ironic that President Clinton is trying to generate support among the elderly for his health-care reform plan by promising them free medicine and long-term care. In fact, the elderly will be hurt substantially under his proposal. The President is proposing enormous cutbacks in Medicare spending and intends to strictly limit health-care spending. When the medical care budget is rigidly fixed, it is obvious that fewer services will be provided. This inevitably means rationing, and the elderly are the most vulnerable group.

Most of the elderly are wise enough to see through the empty political promises contained in the President's plan.

JOHN J. MICHON MD

Los Angeles

* Hillary Rodham Clinton's mean-spirited and irrational attacks on the drug companies ignore the critical question of who will provide the clinical research and development for new drugs, which have been a hallmark of advances in medical therapy in the past several years. Due to the drug companies' activities in this field, we now have superior anti-hypertensive drugs, which have prolonged the lives of those suffering from hypertension and associated complications and have almost eliminated strokes as a cause of death. Another example is the development of useful chemotherapy and antibiotics. Nowhere in the Clinton proposal is provision made for continuation of such research and development of new drugs and techniques. And, by the way, whatever happened to President Clinton's repeated promises for tort reform during his campaign? This was a popular promise and drew much support for him; however, since his election, he has been notably silent in this area. It appears that he is in the trial lawyers' pocket, because of their very large financial contributions to his campaign.

KEITH P. RUSSELL MD

Los Angeles

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