Letters to the editor

Readers react to coverage of the nation's health-care system

Mark Hooper

Thanks, Stanford, for helping us keep single-payer health insurance reform alive.

California will be the leader in further discussion and action for single pay, and as Don McCanne says in “OK, you say you want a revolution,” [Winter 2005 Stanford Medicine], this could happen in years not decades.

California State Sen. Sheila Kuehl’s California Health Insurance Reliability Act, SB 840, is detailed, scholarly legislation that will stand as the Merck Manual for health-care reform and system modernization in the United States.

George Savage
Volunteer, healthcareforall.org
Pacific Palisades, Calif.


I am bemused and somewhat appalled at the suggestions put forth by your Stanford experts for resolving the current health-care crisis in “OK, you say you want a revolution” in the latest issue of Stanford Medicine.

All those who favor “market incentives” are treating health care as a commodity, which it is not. If my financial circumstances so dictate, I can choose lower-priced commodities, or go without certain commodities altogether, and I am unlikely to suffer lingering consequences or death as a result of my decision. With health care, delaying or going without a medication or procedure or choosing a “cut-rate” treatment may have dramatic life-altering or life-ending consequences. Furthermore, as one of your panel pointed out, it is fairly easy for a consumer to get accurate, useful comparison data on almost any commodity, but not on health care. Therefore, I urge you not to conflate a patient with a consumer.

The argument that we are not an egalitarian society, and therefore do not want or need an egalitarian health-care system is also troubling. As the inequities in our society grow ever wider, it is imaginable that many more citizens will die from lack of access to health care than already do. And the number, in your sidebar, is startling — that’s more than died last year from AIDS!

Not one of your writers examines the inherent conflict of interest built into a system where the providers of health care are beholden first and foremost to stockholders, whose interests are generally opposed to those of patients. This is why many of us feel only single-payer systems can deliver quality care at reasonable prices. No one mentioned the grossly inflated administrative burden we pay, nor the fact that the dollars spent on administration are classified as “health-care expenditures.” Health-care expenditures that pay for no medicine, testing, treatment or care!

Finally, it is evident that all of your panel has adequate employment, income and health insurance. If they did not, they would surely view the situation differently. For someone like myself, who is over 55, self-employed (by circumstance, not choice), sporadically paid and about to be uninsured due to lack of funds to pay the premiums, the issues look quite different.

M.C. Kenny
(“Peeved in Palo Alto”)


I agree with Dr. Ellwood in “And now for something completely different” [Winter 2005 Stanford Medicine] that the U.S. health-care system is a disaster for the provider. We both have experience as a patient. We share, among other things, a serious horse-related injury. Unlike him, I found my health care excellent in every respect. I am cared for by a physician-owned 400 MD multispecialty clinic and HMO. We still find the paper and e-mail work of health-care systems, especially Medicare, a major hindrance to good patient care.

What is needed for effective health care is a good doctor seeing a responsible patient. If these two elements are present, the result will be optimal unless the health-care system screws it up. If you don’t have these two elements, no amount of regulatory fiddling will ensure a good outcome. Whether acknowledged or not, the main energies of the organization focus on the benefit and needs of the organization. In the case of health-care systems, the system comes first and the doctor and patient are distant seconds. If you can’t change that, benefit for the patient is unlikely.

Daniel T. Peterson
Stanford MD ’73, Janesville, Wisc.


The Stanford Medicine Winter 2005 articles on improving U.S. health care were interesting but disheartening — so many experts with so many grand and different schemes to improve our health system. Since those outstanding specialists can’t present a common national approach, it is not surprising government officials and the populace are confused.

Consider a “bottoms-up” approach. Kaisier-Permanente has a large and successful HMO. Why can’t it be generalized? Oregon developed and implemented a rationing system developed by hundreds of small citizen-professional groups. It sounded great several years ago. Is it a model for other states?

Perhaps Stanford Medicine could tackle such a topic.

Charles H. Markham Stanford MD ’51
Professor emeritus of neurology
UCLA School of Medicine


The articles comprising “The Ticking Time Bomb” were interesting but 20 years too late. Those of us in the trenches of medical care have been discussing, virtually yelling about these matters for at least that long. During those years the voices of academic medicine have been remarkably silent.

Alain Enthoven’s celestial pronouncements and Victor Fuchs' more cogent comments notwithstanding, there has been little, if any meaningful, sustained involvement in organized medicine by any member of the Stanford academic medical community. In truth, can anyone remember a member in the academic line being promoted on the basis of leadership (such as in California Medical Association or the American Medical Association)? Our repeated invitations to participate have been met usually by a benign smile and an indication that such activity was irrelevant to, if not inconsistent with, one’s academic future.

We have now arrived at the point where patients have no grasp of their medical future, physicians feel sidelined in the process and politicians are literally frightened to death to discuss the problem. Whatever the Draconian solution, I will not look to those in academic medicine to be part of solution. How sad.

George H. Koenig Stanford BA ’56, MD ’60
La Quinta, Calif.

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