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Congress and Fixing Health Care

October 15, 1994

Re "Rx for Recovery--Next Year," by Theodore R. Marmor and Mark Goldberg, Commentary, Oct. 9:

First, the article assumes that Congress wants to change the extant system of providing medical care. Second, it assumes that critics of the Administration's plan bothered to read it. Both these assumptions are false. We will not see reforms of any kind until the Congress is divorced from special interests, and becomes responsive to the needs of the nation.

RICHARD A. BEHAN

Monrovia

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Re Karen Engberg's "What If Health Care Were Run Like the Schools?" Commentary, Oct. 10:

In comparing single-payer health insurance under Prop. 186 to California's public school system, Engberg misses a very important point. Our schools are single-provider, like England's health care system, not single-payer. Under 186, health care providers would still be private, and we would still benefit from competition among them. Only the payment would be managed by the state.

And although Engberg's concern over government inefficiency is legitimate, I don't believe it would match the billions of dollars in profit California's health insurance industry takes out of our pockets every year.

STEPHEN A. MILLER

San Diego

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Gregg Easterbrook's article (Opinion, Oct. 2) is a knee-jerk response to a problem which does not fix easily. If only he could throw out the "insurers" who "paper shuffle," then he could "price-fix" doctors and end up with a wonderful Canadian medical system.

Actually the problem in solving health care is that each of the component "special interest" groups provides valuable services that cannot be thrown out without danger to the overall system. The much-maligned "paperwork" to which Easterbrook refers is actually "utilization review"--the only current method by which scarce financial resources are allocated within the indemnity medical system.

Consider a medical system without utilization review: More money is spent on trivial care while less money is spent to treat major illness and push forward the frontiers of care.

But "utilization review" is only a first-generation solution to medical resource allocation. Those who wish to cure health care should push toward the second-generation solution of "protocols"--an "operator's manual" of those things which work in health care. Each doctor thinks he knows what works for himself through his own lifetime of trial and error, but he doesn't communicate his results to a common database. Protocols will take many years to perfect. In the meantime, insurance professionals ask intellectuals like Easterbrook to respect our determination to allocate medical resources in the best manner currently possible.

RICHARD VALENSTEIN

Orange

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Actually, I much prefer the detailed thoughtfulness of the Clintons on health care to the smug, simplistic approach that we hear repetitively from Easterbrook.

In a larger sense the problem is not with his particular point of view--which does have some merit--but with too many influential Americans all over the political spectrum who, like Easterbrook, espouse a belief in universal health care and the need to control costs, yet will bash any proposed plan that does not conform to their own economic advantage, convenience or sense of ideological satisfaction. As a result we get nothing.

HYMIE MILSTEIN MD

Studio City

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