Re "Bush, Frist Share Vision to Reshape Their Party," news analysis, Dec. 22: Ronald Brownstein says that Sen. Bill Frist (R-Tenn.) will provide health care for Americans by using tax credits and providing stipends to seniors so they can buy their own health plans, thus eliminating the need for Medicare. Neither of these proposals will work because those who need health insurance the most, workers in minimum-pay jobs, do not pay enough in income taxes to cover the costs of health care, which today for a family of four runs about $500 a month. No income tax credit for these people will cover the cost of health insurance. As for providing a stipend to buy private health insurance, this will suffer from what the insurance companies call "adverse selection," meaning those who don't have health problems may not buy it and spend the stipend for rent or something else. Only those who expect to be sick will buy it. Insurance doesn't work unless you have a large number of people who never make a claim in your insurance pool.
Private health insurance is not as efficient as Medicare because private insurers have a cost of sales, in the form of advertising and agent commissions, which Medicare doesn't have. Medicare's overhead is under 4%, compared with as much as 30% for private insurers.
Robert C. Mason
Re "Frist's Possible Conflicts Seen as No Problem Under Senate Rules," Dec. 22: Medicare reform, prescription drug legislation and the problem of the nation's more than 40 million people without health insurance are high on the Senate's agenda. For the following reasons, Frist has an obvious conflict of interest and should recuse himself when dealing with these matters or, better yet, not become majority leader. Frist's brother co-founded (with his father) and helps lead HCA, a huge chain of for-profit hospitals.
Frist, a doctor, became a multimillionaire by acquiring HCA stock. HCA has paid or agreed to pay penalties of $1.7 billion for Medicare fraud and other violations of regulations. Although the senator was not officially in HCA management, it is hard to believe that he did not discuss HCA affairs with his father and brother and was not aware of HCA's illegal activities. Even if there is no conflict of interest under Senate rules, when looking at the senator's background, common sense indicates otherwise. He should not be involved in Senate business related to health care and related matters.
We are blessed to have a leader of the Senate who is not a lawyer.
The best news for the U.S. is not Sen. Trent Lott's welcome abdication; it's his replacement. Frist brings high energy, focus, self-sacrifice, dedication and long hours to the job -- the same qualities necessary for his successful first career as a heart-transplant surgeon.
How great to see people of this quality and accomplishment in public office. Particularly after the buffoonery, incompetence and drowsiness of the Clinton team: Its poor performance let fester and thrive this international network of madmen that is causing us such grief.
Incidentally, don't fault Frist for not voting until age 34. Most likely, that's when, after he finally completed his marathon-like training and education, he finally got out of the operating room before the polls closed.
Robert Kotler MD