To the editors:

Having just finished reading the article by Levinsohn [“Doctors for National Health,” August 21] on national health care, I must take issue with a number of points in the article. First let me state that I am not a medical professional and have no medical practice to protect; I am a health care consumer–just like most people.

The thought that we should have a single payer national system is ludicrous. The article mentions that Medicare pays only $10 for a visit–well below the cost to the doctor to provide this service. The article also mentions that it is routine for the states to delay payments for months on end–just as Illinois has done. We are now supposed to all roll over and say, “Let’s all rush to have the government take over our medical care!” I don’t buy it. Doctors will be in even worse shape fiscally by being dependent upon this single payer for all payments. At that rate they will all be forced to quit their practices.

One of the factors which most of the proponents of the Canadian system overlook is the major demographic and social differences between the U.S. and Canada. Our emergency rooms are packed with the results of gang violence, a social ill from which Canada does not suffer to as great an extent as the U.S.

The author also dismisses the litigation problem that is prevalent in the United States. Simply having a single payer will not in any sense eliminate the propensity of Americans to sue at the drop of a hat. While lawyers do definitely contribute to this, it is now a part of our culture. Until we change this we will be forced to cover the cost of the malpractice litigation. It is important to note that the largest share of most malpractice awards is not for the actual medical treatment which will be required to remedy a medical error, but rather for pain and suffering. Pain and suffering awards are not in any sense limited by having a single payer.

The article also discusses the fact that doctors will not be required to answer to the single payer for the treatments they provide; the payer will simply pay the physician. Given the current level of intrusiveness of the governmental reimbursement, this is not a realistic expectation. The same individuals who insist that the current payers should second-guess every treatment would be at the forefront in insisting that the single governmental payer should second-guess every action of the doctor. This will result in the tyranny of the bureaucrat being forced upon all Americans.

Regarding the contention that the institution of national health care will not cause all of the current MRI and CAT scan equipment to vanish, this is not the issue. Medical technology continues to advance. The concern is that valuable, new lifesaving equipment will be in short supply, just as they are in Canada.

Until Americans address the larger issue of appropriateness of care, as the state of Oregon has attempted, we will have a major problem in controlling health care costs. The advances in medical technology have brought us to the point where we will need to look to our conscience and as a society determine how much heroic effort is appropriate to save a life. This is a decision which cannot be made by some faceless bureaucrat. It is a decision which must be determined by looking to our moral, religious, and cultural beliefs. We place a high value on human life, but we need to decide whether life without dignity is worth the high financial and psychological cost of sustaining it.

Rather than trying to change the health care system overnight, we need to look at ways of making the existing system work for all of us. The majority of doctors are caring, hardworking individuals. We do need to simplify the provision of medical care and the process of reimbursement. The insurance companies could help this along by voluntarily agreeing to standardize on a single form. Use of electronic claims filing could also drive some of the costs out of the system. Hospitals, especially those in metropolitan areas like Chicago, need to cooperate to share expensive facilities and equipment.

We also need to examine how we as a society can cover more of the uninsured. One often missed contributor to the rise in health insurance costs are the mandatory coverage items. For example, many states require that all health insurance policies cover in vitro fertilization and other artificial insemination methods. People should have the right to consciously buy insurance which only provides the coverage they desire and not be forced by the government to pay for insurance they do not want–or be denied coverage because they cannot afford all of the bells and whistles that some legislator decided the world could not live without.

We also need to examine the incentives built into the system which lead to perverse outcomes. For example, the government had for years compensated a hospital based upon the amount of capital expenditures it made. Doctors also need to feel comfortable that the requirement to practice defensive medicine is no longer necessary–this may require some revision of our current legal damages award policies. Above all, people need to take more responsibility for their own health.

G. Rober Malthusian

W. Wellington