M. Todd Williamson in “Grappling with a leviathan” (Commentary, Aug. 23, p. 22) yearns for a time “private contracting—which is the touchstone of American freedom and liberty” that never existed? Healthcare in the U.S. was available only to those who could afford it, except for the care charitable institutions often operated by religious groups provided. The Social Security Act of 1965 that created Medicare and Medicaid was not an attempt to defile history. It was rather a recognition that what we were doing and where we were headed as a country was not addressing the healthcare needs of our seniors and economically disadvantaged. The Hill-Burton Act was influential in the development of hospitals and healthcare, enabling the associations Williamson represents to flourish. So to look for a return to a nonexistent state is essentially the basis for a non-argument. What the article proposes is an expansion of the pot for physician reimbursement. This is not the answer to maintaining a basic healthcare system for all and avoiding national bankruptcy. It is a myopic approach that flies in the face of sound business principles and science. The clichés about the “quality of medical care must be made by the profession of medicine—not government or third-party payers” are either an attempt to mislead the general population of consumers or an uninformed position. Are auto mechanics or airline pilots making the policy decisions for healthcare? I would submit that those policy decisions are based upon good science, where possible and sound medical advice from seasoned professionals. This is reminiscent of the ‘death panel' debate. The country has made a decision that basic healthcare is essential for all of our citizens. To get there we need to change how we function; to break the mold and look beyond our own wallets and folklore about the “American Way.” If you objectively look at a number of other countries, their life spans are longer, infant mortality lower and healthcare costs less per capita than ours. What is the big mystery? Many in our country stand to economically lose if the healthcare industrial complex is shrunk, while the more effective community-based primary-care approach is expanded.
Robert E. DetorPresident & CEOLong Island HomeAmityville, N.Y