A Second Opinion on Health Care

Briefly stated, the thesis Dr. Lloyd M. Krieger’s presents (“An 1890s Law Keeps Health Care From Advancing Into the 1990s,” Sunday Forum, Oct. 29) is that the antitrust law “keeps health care from advancing into the 1990s” by prohibiting doctors from forming their own networks to collectively negotiate with payers--primarily HMOs. He says that the HMOs now dominate the market. Given relief from this prohibition, he asserts “doctors would be in a position to act effectively as agents for their patients.”

True enough--they would be in that position. However, they have been in that position before. The good doctor admits that up to 1970 doctors controlled medical care! . Had they acted very effectively as agents for their patients then, our health care system would not be in the sad shape it is now.

HMO control may be worse for patients that doctor control, but neither is good for patients. It seems clear that to balance market power, patients must have their own agency to negotiate for them with no conflicting interest of any kind. Unfortunately no such agency is currently in sight.

LEONARD PODE

Sherman Oaks