Hard Choices in Health Care

Victor Cohn's examination of how health care is rationed {Cover, July 31} points out the difficulty of the choices that confront us. In an effort to contain costs and increase access, Oregon is attempting to deny services to the population with the least political clout -- poor women and children.

Although Oregon policy makers should be commended for seeking bold solutions to the de facto rationing that occurs in every state under the current Medicaid program, they have produced a cure that is as bad as the disease. Tinkering with the Medicaid system is unlikely to produce significant improvement.

Health policy leaders across the country are slowly joining pediatricians in the realization that the Medicaid system cannot be "fixed." As the Pepper Commission recently recommended, a new system is needed if we are to adequately and equitably meet the basic health needs of children and all those without health insurance. Birt Harvey, MD President American Academy of Pediatrics Washington Helping Judges Understand Medicine

In a commentary on health care issues that are decided in court {Second Opinion, July 17}, the case of a young mother with breast cancer that was recently decided in U.S. District Court in Alexandria was summarized. She had to sue to compel her insurer to pay for a self-donation of bone marrow to try to stop her late-stage disease from spreading.

Autologous bone marrow transplant has evolved over the past four years from an experimental procedure to a well-recognized, often used technique for advanced cases of breast cancer. While standard chemotherapy held a terrible prognosis for these patients, this new treatment offers dramatically better chances for long-term survival.

In this particular case, a number of highly regarded board-certified oncologists testified to the effectiveness of the therapy.

It is such arbitrary, unscientific decisions that are forcing patients to take their insurance carriers to court to provide generally accepted, state-of-the-art therapy. James W. Reinig, MD Annapolis What Mammograms Miss

Publishing information on the importance of Pap tests {Consumer News, July 24} was a useful reminder of its value in testing for cervical cancer. The Pap test does not, however, detect another form of cancer that occurs in the lining of the uterus, just beyond the cervical area sampled by a Pap smear.

Women, including those who have annual Pap tests, can be devastated to learn that advanced cancer of the endometrium, the uterine lining, can exist while they are testing negative for abnormalities on the Pap. Lee Agree Washington

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An article on water {Health Plus, July 31} incorrectly stated the daily recommended intake. It should be at least six to eight 8-ounce glasses of water.