* I read with interest the excellent commentary by Alan J. Goldman, M.D., (Orange County Voices, Jan. 21) regarding how managed care is killing the practice of medicine.
Excluded from his article are some data which may interest your readers. For example, for many major health insurance carriers, as little as 35% of the premium dollar is now going to pay benefits, with 65% going to profits and administrative costs including the costs of managed care. Insurance companies are making so much money that some of their chief executive officers have been given annual bonuses as high as $52 million.
Meanwhile, doctors continually face increased overhead. For example, in the past year, my rent increased 5%, malpractice insurance premiums 30%, employee salaries and benefits (except my own) 10%, and other expenses 35%. My own salary and benefits declined 33% despite working a similar number of hours. If I worked only 40 hours per week, my net wages and benefits would be less than my plumber or gardener or the nurses at the hospital.
Three major carriers decreased the amount that they are now paying me for my services, and now Medicare is doing so in 1996. To add insult to injury, physicians have to spend more and more time completing reports for the insurance companies in order to justify their services, giving them less time to treat patients and earn income. Most physicians no longer encourage their children to become doctors, and this should come as no surprise.
Something must be done to reverse the trend of the past few years before the enthusiasm of those in our profession to save lives and improve quality of life declines.
Furthermore, we must change our priority from being willing to pay attorneys twice as much per hour to sue our neighbor than to pay our physicians for saving the lives of our children.
IRWIN I. ROSENFELD, M.D.
College of Medicine
* Regarding Dr. Goldman's Orange County Voices article: He is perhaps too young to remember how the American Medical Assn. sought to strangle Medicare at birth and has, ever since, been content to gouge it to death.
Time and money spent on AMA lobbyists to prevent "socialized Medicine" (i.e., government supervision) could have been better spent in research and human services.
If only all doctors truly cared as much for the health of their patients as for their "wallet biopsies," HMOs wouldn't have become necessary.
So-called "managed care" is somewhat reminiscent of the incipient labor movement. Unions began as an idealistic attempt to right wrongs. Money is not the root of all evil, but love of money is.
MARJORIE A. GROSS
* I read Dr. Goldman's "Commentary on Medicine" with interest.
While I agree that the current health care system requires reevaluation and am concerned about the motivation for profit before quality patient care inherent in this and previous systems, I am startled by the tone of apathy when it comes to "caring" for his patients in the face of less "gratifying" circumstances.
Surely, this is the test of true altruism, the unselfish concern for the welfare of others. What does gratification, financial or intellectual, have to do with altruism?
An economic "bottom line" is a reality for today's health care providers, but health care standards are the responsibility of its individual practitioners, not its patients.
My answer to the frustrations imposed on health care practitioners by managed care is accountability; a strong, nonadversarial voice where patient welfare is at stake; a well-informed patient; and a willingness to embrace change.
Ironical that two pages following Dr. Goldman's article the headline reads, "Doctor Convicted of Insurance Fraud," another uncomfortable reality.
FRANCES A. ASPINWALL