"May I add a postscript to your items on Medicare-Medicaid?" asks Leo Orso of Silver Spring.
"I could match all the horror stories you have printed thus far, ranging from what I consider outright corruption (charges for work not done), insensitivity, excessive delays and outright misrepresentations. These include hospitals, physicians and labs.
"Let me try to be costructive by offering a couple of suggestions which would be easy to achieve but will inspire (as per usual) resistance from the medical-technological-bureaucratic complex.
"A Medicare to publish a list of physicians who accept assignment , so patients will know within a reasonable degree what their costs are going to be. pAfter all, Blue Cross I believe publishes a list of physicians who will write "paid in full" for what Blue Cross pays if the patient is in a certain income bracket.
"B. Post fees for many basics that Medicare allows, i.e.: blood pressure checks, office visits, etc. I have seen one such schedule posted on the wall of a pediatrician (woman).
"C. Phase out independent laboratories and X-ray departments within the hospital.Operate them on a salaried basis. This will help avoid some of the outrageous use of X-rays, some of the kickbacks etc.
"D. Notify patients of changes in fees, especially where large jumps are made. Such as our eye doctor who in less than two years jumped from $15 for a glaucoma check to $25, plus $25 for field test for which Medicare paid $8. Thus $50 for a 10-minute visit.
E. "A vigorous effort to prosecute the corrupton whether small of large. When I called Medicare and complained about being charged for work not performed they said they had nothing to do according to law but pay the charges. A week later, the same hospital charged with allegedly cheating patients out of $383,000 in a single year. I have a lot more to say but I have run out of paper."
During the past few weeks, I have received enough letters about health care costs and insurance coverage of various kinds to keep a team of investigative reporters busy for months.
Perhaps the saddest aspect of the matter is this: if investigators ever assemble all their facts, no universally acclaimed solution to the problem would emerge. There would still be need to find compromises that could command a majority in Congress.
It is true that some doctors charge far more than other doctors for standard services. But this is also true in other trades and professions. When my solid state Zenith Chromecolor II TV decided to turn itself into a black-and-white set last week, I began phoning TV repairmen. I asked the same questions of each, but no two of them gave me similar answers.
"What usually causes loss of color?" brought answers like: "Usually it's a burned-out module." It could be anything." "Have your antenna leads come loose?" "We'd have to trace all the color circuits; it could take a couple of days to find out." "It might be just a burned-out tube." "Sounds like your picture tube."
How much might it cost to repair the set if it were brought in to the shop?" "The labor would be $72.50, plus parts; the one module is about $40 but I couldn't tell until we looked at it what else it might need." "The labor on it would run $12 to $18, and the parts would be extra, of course." "We'd be happy to give you a free estimate if you brought it in. "Our labor charge is $28 for the first half-hour or less. Beyond the first half-hour we charge $30 an hour for labor. I couldn't guess how long it might take to find the trouble in you r set and fix it."
It is obivious that if diagnosing and repairing a standard malfunction in a box of electronic circuits lends itself to ambiguities and variaitons, then attempts to diagnose and repair the infinitely more complex human body can lead to even greater variations.
Having recently celebrated the third birthday of my second life -- the life doctors provided for me after I reached their operating table a half inch from death -- I am not an advocate of laws that attempt to force all doctors into a single mold.
However, it is clearly the will of most Americans that their government play a role in bringing health care within the reach of all. And there is clearly a need for some doctors and others in the health care industry to come forward voluntarily and say: "I would like to participate in this undertaking. Can we work out a tripartite understanding that all of us will abide by because all of us will deem it equitable?"
Compensation paid to doctors, technicians, nurses and others should be set at a fair level and adjusted frequently to keep it fair. Any doctor who thinks his services are worth more should be free to post a sign in his waiting room that warns patients, "I do not accept insurance assignments. I set my own fees."