Sample Letter to the Editor

Letters

Sunday Dialogue: Curing the Health System

Published: August 27, 2011

A letter on Wednesday urging a single-payer health plan, rather than individual mandates, set off an outpouring of reaction.

The Letter
To the Editor:
In “Will Health Care Reform Survive the Courts?” (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that “reforms would work far less well without an individual mandate” that requires citizens to buy health insurance or pay a penalty.
I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress’s power to mandate purchase of private products sold at a profit is disputable, but Congress’s power to tax is not.
Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don’t use mandates that allow insurers to charge different prices for different people.
These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.
There is no need to experiment with mandates. Convert our current health care system into a national health plan.

SAMUEL METZ
Portland, Ore., Aug. 21, 2011
The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.

 
Readers React
 
Dr. Metz is spot on with his advocacy of a single-payer plan instead of the individual mandate.
Sadly, despite the success of Medicare — a single-payer system that politicians tamper with at their peril — the “just say no” climate in Washington, fostered by Republicans who place ideology over country, took that option off the table and left us with an alternative that not only raises legal questions but also fails to address the real threat: the escalating costs of health care.
That said, the health care plan that the politicians have given us, which extends protection to millions of uninsured, is better than no plan at all.
After decades of talking about reform, we finally have a plan in place. With luck, a day will come when the political will for a single-payer system exists.
Until then, let’s do our best to make the plan we have work.
JAY N. FELDMAN
Port Washington, N.Y., Aug. 24, 2011


Dr. Metz is right that a single-payer system would be better than an individual mandate. But he does not mention that Medicare, although it is a single-payer, tax-supported system, still cannot control costs and will soon be bankrupt. A national health plan that controls costs needs to reform the way doctors are paid and are organized in practice.
This is how doctors, if they are really “mad as hell,” could help. They should join salaried multispecialty, not-for-profit group practices that can accept capitated prepayment for comprehensive care instead of fee for service, and can provide good, cost-effective care that supports primary-care doctors working in close collaboration with specialists.
ARNOLD S. RELMAN
Cambridge, Mass., Aug. 24, 2011
The writer, a physician, is professor emeritus of medicine and of social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.

 
Dr. Metz’s call for single-payer national health care imposes costs on taxpayers rather than directly on those being served. Patients are not charged more for services they value the most or are more costly to provide. Tax bills simply rise in sync with something else like income, property or sales.
It takes no leap of faith to understand how this will affect demand for health care. Anyone who has dined at a fixed-cost food buffet knows the outcome of not directing price with food portions.
It is tempting to believe that government will fairly and efficiently make these choices for us, but experience suggests otherwise. Dr. Metz appears to anticipate this problem given his suggestion that Congress’s power to tax is indisputable and so government will predictably raise taxes to pay for growing demand for health care.
MICHAEL L. MARLOW
San Luis Obispo, Calif., Aug. 25, 2011
The writer is a professor of economics at California Polytechnic State University, San Luis Obispo.