Re "Should a Gardener Get the Same Care as a Vice President?" Commentary, Feb. 12: The weakness of Leslie Saxon's nanny-state worldview is exposed by two fatal flaws in her argument. The only way to make medical procedures equally available to the gardener and the VP is by legislating mediocre (or worse) service to all. I wonder how many $30,000 implantable cardioverter defibrillators (ICDs) are implanted in the medieval single-payer systems in Canada. Canadians routinely descend on our northern cities for unavailable treatments that we take for granted -- MRIs, joint replacements, et al.
Second, I don't think Saxon has read the Constitution regarding the federal government's role. Wondering how to deliver $6 billion of services, she asks, "What about the other needs our government must fulfill?" and lists "homeland security, Head Start programs or assistance for struggling theater companies." She has to be kidding. Only one of those needs is enumerated in the Constitution: national defense. Dr. Saxon, please stick to healing and leave national policy to clear-thinking citizens of different talents.
Saxon raises thought-provoking questions about the ability of our society to provide essential health care for all. Studies demonstrate that getting consumers involved in their own health-care decisions, across a large group of people, provides enough savings so that high-cost, unavoidable medical care could be economically provided for everybody. If catastrophic health insurance were made mandatory across society, much like auto insurance, Saxon's patient would be covered for essential care, either through this coverage or through an expanded safety net, depending on his income.
But this will work only with a health savings account, medical savings account or similar approach that lets us make our own decisions about care without the interference of health plans. Several proposals have combined this catastrophic package with provisions to cover preventive services, to lead us toward more healthy lifestyles and get needed care early (e.g., blood pressure medication) versus later (care for stroke, heart attack or kidney failure). President Bush and several congressional leaders are interested in expanding these approaches, and both doctors and the public must learn more about them.
San Diego County Medical
Society, San Diego
Saxon asks if a gardener's life is less important than the vice president's. Of course it is. Think of the revenue we save by just letting the gardener shove off. Not only do we save the price of his "whatchamacallit," his forgone Social Security benefit will make someone a nice tax cut. The longer the poor dodo lives, the more enfeebled the supply side will become. What will we do then? Sell things to each other? We had half a century of that and we couldn't stand it.
Think of the gardeners, yacht brokers, sommeliers, etc., who will have jobs once the veep and his cronies collect on the tax cut. Let the little folk go down to Walgreens and buy ICDs if they want them so badly. Meanwhile, I say keep the go-getters energized. By what means -- other than recycling the gardener -- does the good doctor suggest we scrape together the boodle to lure entrepreneurs out of their wine cellars and into public service? Fact is, Dr. Saxon, one gardener isn't likely to employ very many beyond retail clerks, haberdashers and town councilmen. By contrast, the vice president is a river to his people. No dynamic colony lets its aphids imbibe the liquor of its queen.
Sierra Vista, Ariz.