Letters: Aug. 3, 1998

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WHAT YOUR HEALTH PLAN WON'T COVER

"The transformation of the health-care industry into an approximation of the used-car industry is socially irresponsible." SPYROS ANDREOPOULOS Stanford, Calif.

Your report on managed care was balanced and thoughtful and mercifully free of the shrillness that characterizes much of the commentary on this controversial subject [MANAGED CARE 1998, July 13]. Of course, managed care is flawed, but with an aging population and increasingly sophisticated--and expensive--technology, it is becoming almost impossible to align the ideal components of a successful health-care system: access, quality and cost containment. One solution is to make employers provide the sources for coverage but let the employee shop around for the best HMO that meets his or her needs. That way responsibility for health care will rest with the individual--and the marketplace. DAVID WOODS, President Healthcare Media International, Inc. Philadelphia

As medical care became a trillion-dollar industry, investors who had made a killing in other sectors shifted their sights to the health-care industry. Managed care is seen as the most efficient way to extract new gold. The less doctors and hospitals provide, the more money they can make. The results: record gains--hospital profits alone hit a high of $21.3 billion in 1996, up 25% from 1995--while more Americans than ever are uninsured. Most of the proposed, limited reforms will merely confine the worst abuses. What is needed is not containment but a fundamental overhaul. ROSE ANN DEMORO, Executive Director California Nurses Association San Francisco

Ten years ago, as an accommodation to my patients who were being forced into managed care by their employers, I joined several HMOs. I struggled with the problem of denials and delays for years. Finally, at a substantial loss of income, I quit them all. I am much less busy, but my remaining patients are happier, and so am I. To pay for their competitive marketing and bloated administrative overhead, the HMOs must raise premiums. It is time to get rid of HMOs. There are 41 million people in the U.S. without health insurance. We need a national, single-payer system. MELVIN H. KIRSCHNER, M.D. Van Nuys, Calif.

It's troublesome that Americans seem to think HMOs "deny their patients proper care." HMOs mostly do exactly what they are contracted to do. If people want more, they should supplement the coverage with their own money or go somewhere else. That's the American way. And if HMOs are making such obscene profits, let's go buy stock in 'em. CHARLES H. LOWRY Garden Grove, Calif.

A for-profit corporation that receives reliable revenues, employs sharp-penciled "gatekeepers" who only grudgingly dole out "care" and cannot be sued may be an investor's dream, but it is a patient's worst nightmare. EDWARD K. GARRISON Chicago

Being in an HMO has saved me more than $10,000 in the past three years. We just had a baby who cost us $10 out of pocket. We've never had a problem with quality issues or failure to pay. GEORGE EVANS Dublin, Ga.