With all of his references to "irony," I found it most ironic that Karl von Schriltz fails to mention the annual earnings of insurance industry executives while criticizing the annual salaries of doctors. ["In Defense of HMOs," letters, July 13]. Although it is true a doctor's $200,000 annual salary is nothing to whine about, it pales in comparison with the salaries of insurance executives. The insurance industry is both wealthy and thriving, and its executives are some of the best paid, most making well over $1 million annually when stock options and lucrative performance bonuses are included.

I disagree with Mr. Von Schriltz's opinion that managed care has "improved the quality of service." We cannot deny that "HMOs have sought to eliminate unnecessary care," but this usually comes at the expense of the patient. How many stories of repeatedly denied coverage and run-around administrative delay tactics do we have to hear from HMO patients? Surely, this is not an improvement on the system. If these cost-cutting practices are allowing more people to afford insurance, then I guess we are getting what we pay for.

If the only way to combat the strong-arm tactics used by the insurance industry to manipulate the health care system in their favor is for doctors to unionize, than I am all for it. Where the quality of my health care is concerned, I would rather see doctors compensated fairly than those funds being taken as excess profit by an insurance company. The Democratic Party's proposals in the "Patients' Bill of Rights" would help put individualized health care back in the control of doctors and their patients. It is for this reason that I will likely vote Democratic for the first time in my life.

SUZETTE M. THOMAS

Ashburn, Va.