Re "A Changing World Is Forcing Changes on Managed Care" (front page, July 2):

Rising costs for health care and increased reluctance by employers to pay for the increase spell unacceptable consequences: more middle-class Americans without coverage and cost increases that hit patients directly (the average insured American already spends $1,300 a year on co-payments, deductibles and items insurance doesn't cover).

The best long-term answer for controlling costs is to turn patients into patient-consumers, arming them with incentives and information to take advantage of the innovations they want and not pay for what they don't need.

Until patients are forced to understand drug costs, for example, they will not have incentives to ask their doctors for cheaper substitutes.

Consumer-driven health care, including ideas like pre-tax medical spending accounts and incentives for preventive care, would create a world that doctors, patients and employers can all live with.  

ANDY SLAVITT

President and Chief Executive

HealthAllies

Glendale, Calif., July 2, 2001

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To the Editor:

Managed care has done irreparable harm to health care delivery in this country (front page, July 2). It has failed to live up to all of its original promises, and has cost human lives for the sake of financial profit. As a former H.M.O. medical director, I must live with the guilt of knowing I participated in one of the cruelest hoaxes ever perpetrated on the American public.

A patients' bill of rights act will not repair the damage. It certainly will not help the millions of Americans who are uninsured. It is time to go back to the drawing board and to get it right.

BARRY K. HERMAN, M.D.

Austin, Tex., July 4, 2001



To the Editor:

Re "A Changing World Is Forcing Changes on Managed Care" (front page, July 2):

Managed care has greatly diminished access to effective treatment for a large segment of the population: the children and adults with mental illnesses, addictive disorders and emotional problems. The patients' bill of rights won't fix our damaged health care system or rebuild our damaged mental health care system.

Managed care has cut financing for mental illnesses to levels that guarantee that effective treatment cannot exist.

There is not enough money for the psychotherapy, hospitalization and intensive treatment that are needed to save lives. Medication alone is inadequate for severe mental illness. We need real mental health care in this country, not just a strong patients' bill of rights.

DEBORAH C. PEEL, M.D.

Austin, Tex., July 2, 2001

The writer is president of the National Coalition of Mental Health Professionals and Consumers.