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Health-Care Controversy

July 19, 1994

* The Times is correct to warn Congress that failure to enact national health-care reform will bring on many ill-considered state initiatives (editorial, July 11). But The Times is mistaken if it believes that political compromise and halfway measures can even begin to address the complex and deep-rooted problems of the health-care system.

This is the dilemma of health-care reform: that the threat of unintended consequences hangs like a sword of Damocles over every halfway measure. These issues demand more than political philosophy; they demand workable solutions. We need universal coverage and genuine reform, not a political snow job.

SIDNEY I. SIEGEL MD

West Covina

* In "Single-Payer Plan for Health Care Sparks Furor" (July 10) you write that the cost of the single-payer initiative, starting at $100 billion per year, would dwarf the state budget of $57.3 billion, which includes the county health program. A thoroughly accurate, unbiased story would indicate that with the adoption of the single-payer plan, there would no longer be a cost factor of health care in the county budget. Workers' compensation medical costs as well as auto insurance medical bills would also be covered, resulting in major savings in taxes and auto insurance.

The ideal story would have also included the fact that as of June 22, the single-payer initiative was unanimously endorsed by the State Legislative Committee of the AARP (American Assn. of Retired Persons), whose California membership is about 3 million. When you consider the fact that AARP derives a sizable income from its health insurance program, its support of the single-payer initiative reflects the overwhelming support of its membership for the plan.

SEYMOUR ROBINSON

L.A. County Deputy Coordinator

AARP/VOTE

* The Times' report on the opposition to the single-payer health reform ballot initiative (July 7) is well balanced, but fails to mention the massive role of insurance industry interests in the coalition of "business groups" opposing the single-payer plan. The National Underwriter issue for June 27 reports that over half a dozen insurance industry associations have roles in the anti-single-payer crusade.

And no wonder. The single-payer plan is able to achieve universal comprehensive coverage without overall cost increases precisely because it eliminates the role of the insurance companies, their enormous profits and administrative waste and the expensive billing bureaucracy and medical care micromanagement that they impose on health-care providers.

DONALD BASHFORD

La Jolla

* Harry M. Goldin's commentary on financial incentives and restraints built into health maintenance organizations (" 'Gatekeepers' May Be Hazardous to Your Health," July 11) inaccurately represents how HMOs work. Goldin cites an HMO patient whose primary care physician handled a dermatological disorder instead of referring to an outside specialist, as an example of HMO financial incentives coercing doctors to undertreat patients. No responsible physician would postpone needed treatment for financial reasons, because doctors are professionals dedicated to patients' well-being, and because postponing necessary care ultimately leads to higher costs when patients experience more serious illnesses that could have been detected early or prevented.

Financial incentives are at work in medicine, as in most professions. Traditional fee-for-service medicine rewards practitioners for providing multiple services, needed or not. HMOs, however, reward doctors for practicing preventive care, keeping people well, continually improving quality of care and adhering to the best practices. The fact is that HMOs provide physicians with powerful incentives to prevent illness and treat patients early on.

HMOs believe that referrals should be based on medical needs and encourage appropriate use of specialists to prevent further complications. The point is to know when to refer and when not to refer. By reducing the frequency of unnecessary referrals, HMOs help patients avoid the risks of overtreatment without compromising needed services and quality of care.

Goldin incorrectly claims that physicians who are "at risk" for care face a conflict of interest. HMOs pay physicians a competitive compensation to provide all necessary care. If a physician denies appropriate care, that physician is violating his or her professional ethics and may be committing malpractice.

HMOs have a proven track record of providing affordable, high-quality, comprehensive health care in California over the past 60 years. Five years ago California HMO enrollment stood at 8 million. Today, nearly 12 million Californians receive quality health care from HMOs.

Twelve million Californians can't be wrong.

MYRA C. SNYDER

Executive Director

California Assn. of HMOs

Sacramento

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