Letters, The New York Times, May 15, 2011
In āThe Missing Fifthā (column, May 10), David Brooks says there are two basic ways to control health care costs: top-down government regulation (President Obama) and shifting costs to beneficiaries (Representative Paul D. Ryan). Neither approach alone or when combined is likely to work because neither improves health care or deals with the real drivers of medical inflation.
Fee-for-service payment, a fragmented and disorganized medical care system focused on providersā income, and an investor-owned private insurance industry all contribute to rising costs. Fraudulent billing, duplicated and unnecessary services, and a large but unknown amount of defensive medicine compound the problem. These factors could be controlled in a public single-payer system that paid private not-for-profit organized groups of salaried physicians on a capitated basis to deliver quality care.
Difficult as such reform might be to achieve, there is hope in the fact that we are already spending enough to pay all the costs of a greatly improved system. Our problem is primarily political, and it should not take many more years for the general realization that major reform is not just the best, but the only, way to control costs.
ARNOLD S. RELMAN
Cambridge, Mass., May 10, 2011
The writer is professor emeritus of medicine and social medicine at Harvard Medical School and former editor in chief of The New England Journal of Medicine.