Unionization of doctors will do incalculable damage to our health care system ["AMA Votes to Unionize Doctors," front page, June 24]. The irony is that roughly 750,000 professionals earning an average of $200,000 annually -- putting them among the wealthiest Americans -- are whining about managed care crimping their entitlement to large annual pay hikes.

Beyond the irony, however, is the danger that unionized doctors could hold this nation's health hostage to wage demands. The more expensive health care becomes, the less of it we can afford. Managed care, lawsuits and drug companies have become shopworn red herrings in the health care debate, obfuscating the central role doctors have played in health care cost escalation.

Managed care was the market response to runaway health care costs in the 1980s -- often rising at two to three times the rate of inflation -- that left 30 percent of the U.S. population with little or no health care. And so far, managed care has worked: Health care inflation in the 1990s has remained at or only slightly higher than the consumer price index, and competition among HMOs for members has improved the quality of service.

HMOs have worked largely by reining in the excesses of the old Blue Cross fee-for-service system, created by doctors for doctors.

HMOs have sought to eliminate unnecessary care while better coordinating the purchase and use of expensive technology. While this has deflated bloated doctors' paychecks -- especially for specialists -- it gradually has increased health care productivity, bringing costs down and widening coverage.

Doctors should not be allowed to hold patients hostage to wage demands. Congress must not grant doctors antitrust immunity and allow unionization to replace demand creation as the new engine driving doctors' wealth -- and health care costs.

KARL von SCHRILTZ

Washington