As a family physician, I read your proposal for health care reform with great interest ("A prescription for reform," Social Issues, Oct. 7). While it has significant merit, I would offer several comments. The estimate that 30% of care is unnecessary may be true, but the suggestion that this is due primarily to physician greed is not. I work for a nonprofit clinic: I'm paid a salary, and therefore I have no incentive to overtreat. However, I often find myself ordering tests that aren't medically necessary or admitting patients who could be managed outside the hospital because of patient pressure and to protect myself or the emergency room physician from litigation. Malpractice reform, with a cap on pain and suffering awards and decision-making by an arbitration panel, is absolutely necessary for any health care reform package.
In addition, you mention that gatekeepers will usually be internists. Actually, family physicians are the most highly prized gatekeepers because of their specialized training in primary care medicine and their ability to see a wide variety of patients.
Mark Ebell, M. D.
Your story contains a good many observations and ideas. And I'm pleased to see that BUSINESS WEEK is making specific recommendations. However, the funding proposal is absurd. It is unconscionable, in my mind, to recommend further complicating the already fathomless U. S. tax code. Additional employer classification schemes, surcharges, and tax credits are not acceptable. With the exception of the progressive characteristic, social policy should be separate from tax policy. Only then can we hope to reasonably simplify our tax systems.
John R. Schuyler
Managed care is why we have 30 million people not covered by medical care, millions more that have minimum care, and why insurance companies gobble up a quarter of the health care dollars. Back to the drawing board. The ship you designed is so full of holes it looks like Swiss cheese.