I was disappointed with C. Everett Koop's Dec. 23 op-ed column. Finally, after years of coverup, the medical profession is forced to confront the reality of an epidemic of medical malpractice. Dr. Koop is wrong when he states the threat of litigation forces physicians to hide their mistakes.

As an attorney whose firm handles many medical malpractice cases, I know that most physicians are caring individuals who are more concerned about their patients and future patients than Dr. Koop gives them credit for. He and other critics of the tort system also ignore the reality of the tremendous costs to care for seriously injured victims of medical negligence and the devastating consequence of losing a loved one.

While I agree that changes can and should be made to reduce medical errors, I don't think it can be accomplished over the bodies of the victims.

ROGER E. GREENBERG

Silver Spring

Two apparently unrelated stories about health care on the front page of the Dec. 14 Business section warrant comment.

One piece, "Drawing a Bead on HMOs," told the story of Connecticut Attorney General Richard Blumenthal's lawsuit against a large HMO in the Northeast. The suit targets the HMO's methods of managing the cost of prescription drugs and is the latest in a wave of lawsuits against HMOs.

The other article, "Health Costs Hitting Small Firms Harder," reported that firms with 10 to 49 workers experienced an average 13.8 percent increase in health insurance premiums this year.

I think the stories are linked. Between 1993 and 1998, soaring prescription drug costs accounted for almost 40 percent of the rise in health costs paid by private employers. And the prediction is that drug costs will increase 10 percent to 15 percent a year over the next few years. HMOs and other managed-care plans are struggling to get a handle on these costs while making sure their enrollees have access to the drugs they need.

A managed-care industry beset with lawsuits that undermine its means of ensuring appropriate and cost-effective care is going to have to raise its rates--plain and simple. That will lead more small businesses to either drop or scale back coverage. That, in turn, will increase the number of people who are uninsured. The sledgehammer of indiscriminate or frivolous lawsuits is not the way to solve our health care problems. And such lawsuits could well backfire in the long run.

NANCY CHOCKLEY

Director

National Institute for Health Care Management

Washington

The National Institute for Health Care Management is a nonprofit group that receives funding from managed-care firms.