To the editor: David Blumenthal and Sara Collins rightly point out that many European systems provide coverage through a mixed public-private approach. These countries have uniform and generous benefits packages, and have largely or totally disentangled coverage from employment.

Still, evidence shows that the less private insurance and employers are involved, the more cost-effective and equitable the system. The greater the role for private insurance, the higher the administrative costs and complexity.

We Americans must ask ourselves two questions with respect to our healthcare system: How much wasteful complexity and bureaucracy do we want? And much inequality do we want?

The authors are correct that “Medicare for all” isn’t the only way to cover everybody. It’s just the most efficient and the fairest way.


Steve Tarzynski, M.D., Santa Monica

The writer is president of the California Physicians Alliance, a group that advocates for single-payer healthcare.

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To the editor: Blumenthal and Collins outline a very sensible blueprint for healthcare reform.


An efficient universal healthcare system should be based on primary care. To overcome the shortage in primary care physicians, medical school students can be promised an essentially free education if they agree to serve in primary care for a stipulated length of time.

There is no doubt that a significant proportion of medical costs are due to defensive medicine to avoid malpractice suits. A no-fault system similar to workers compensation or requiring gross negligence as a measure of liability would go a long way to decreasing costs.

Prescription costs must be brought under control through legislation or negotiation as they are in other countries.

Of course the socialists, specialty associations, trial lawyers and pharmaceutical companies would not like this, but hopefully the public would benefit.


Arthur L. Wisot, M.D., Boca Raton, Fla.

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To the editor: Blumenthal and Collins’ article is interesting, but as with many articles about Medicare, there is no mention of the reality that the private insurance market is deeply intertwined with Medicare through supplemental plans and Medicare Advantage (HMO) plans.

Without private insurance company involvement, Medicare would not function. And nobody mentions it.


Patrick A. Mauer, M.D., Pasadena