1-Payer System Is Best for Health Care

* I read Roselle Lewis’ “Let’s Put the Caring Back in ‘Managed Care’ Medicine” (Valley Commentary, Jan. 2) with some sadness. I was sad that once-caring physicians are now portrayed as coldly indifferent and uncaring. However, I am pleased that Ms. Lewis recognized that this had something to do with managed care.

By its very nature, managed care is a cost-control method of providing medical services. That concept in itself can be worthwhile. But as Medicare recently discovered, encouraging senior citizens to give up their Medicare insurance and enroll in health maintenance organizations actually costs the government over 5% more than if the seniors had remained on regular Medicare.

Several things contributed to Ms. Lewis’ unfortunate experience.

Firstly, there is fierce competition between the insurance companies that offer managed care. A significant amount of the premium dollar is spent on promotion and marketing. A substantial amount of money is also spent on administration, operation and profit margin. Furthermore, reserves are usually set aside to cover unexpected expenditures.

The primary physicians are encouraged to minimize the use of specialists and hospitalizations by the insurance company’s promise to split that reserve if careful use of costly services results in a surplus of money. That may make good business sense but is no more ethical than the fee-for-service problem of over-utilization for profit.

The problem is that not one cent of all of the above-described expenditures is used for patient care. President Clinton stated that these so-called administrative expenses could represent as much as 40% of the premium dollar.

I agree with Ms. Lewis that we certainly need universal, patient-oriented, compassionate coverage for all Americans. But it’s not going to happen via managed care. We need to get rid of the money-oriented insurance companies and create a bare-bones one-payer system with strong overview built in to prevent fraud and misuse. Then we will again be able to choose doctors whose only concern is giving us appropriate, quality care.

MELVIN H. KIRSCHNER, M.D.

Van Nuys