Second Opinions On `The Hospital'

Your article about the economics and sociology of medical-care "reforms" was outstanding ("The hospital," Cover Story, Jan. 17). It was the most authentic and accurate analysis I have seen in a newspaper or magazine during the past five to six years.

For 10 years, I have told patients and friends that they should visit a Veterans Administration hospital for a day or two before they get too enthusiastic over these cries for health-care reform.

The 24.5% expenditure for administrative costs of pretreatment approval, in-patient review, Medicare audits, compliance with methodology and coding required by the Health Care Financing Administration, etc., has not really saved money by reducing waste (unnecessary treatment), and it has

siphoned money away from patient care.

The public ought to be able to read these implications.

Dr. Marvin J. Noble


If there is anything that illustrates why there are problems in health care in America, it is the article "The doctor." Dr. Robert G. Blabey complains that he "can't make decisions."

Fact: A physician has no right to make decisions. The customer has the sole right to do so. ("Patient" is an insulting term that has no place today.) The customer has the right to hire a physician, as one would hire a television repairman or a plumber, to perform the procedure that the professional medical literature, not some greedy, self-interested physician, indicates is appropriate.

James Haney

San Antonio

Thank you for your dramatic but accurate account of the administrative strangulation of American hospitals. I knew we were in trouble some 10 years ago, when I first counted more billers in the billing department than we had patients in the hospital.

Last month, I treated a child with a complication of hemophilia with a new, experimental drug. Nothing else has stopped his bleeding; the new drug did. Each day I gave him the drug, I had to fill out 97 forms. What shall I

do if he bleeds again (as he probably will)?

At least, in this complicated case, an expert was allowed to treat the child. We weren't told that some health maintenance organization (HMO) or preferred provider organization (PPO) refused to refer him to an expert, as usually happens. I usually have to threaten the HMO/PPO that if they get a bad outcome with their complicated case, they could be sued, but even that doesn't always work.

Dr. Carol K. Kasper, Director

Orthopaedic Hospital Hemophilia


Los Angeles

It seemed to me you omitted a very essential element. The reason that so much paperwork is required is the fact that doctors, hospitals, and others were performing many unneeded services at very high fees--and of course, they still are.

L.A. Peterson

Sun City, Ariz.

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