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Single-payer system can offer economy, quality

Recently I attended a conference in London for American, Canadian and British medical sociologists. So it was with much interest that I read recent letters to the editor making claims for the low quality of other countries' health care and the inferiority of the British system of paying for health care. I thought I might add a few easily verifiable facts to illuminate the discussion and relinquish it from the liberal/conservative battle lines.

Americans will spend approximately $1.3-trillion in 1999 for mainstream health care. That places us No. 1 in per/capita spending compared to the rest of the world. Of that, 8 to 9 percent is spent on administration costs. The British Health Service spends less than 2 percent on administrative costs. Ask physicians or hospital billing bureaucrats and they will tell you how much labor goes into figuring out the various rules and regulations for the many private insurance companies they deal with. Simply by changing to a single insurer (the government) $90-billion could be saved.

So, we spend more on health care than any other citizens. Don't we get a better product? No. Judging quality of health care is tricky business because all health care providers are affected by the cultural milieu in which they reside. But we can compare things such as health outcomes and access to the system. Here is a sampling of this comparison: Infant mortality (deaths in the first year of life per 1,000 live births) in the United States is 7.3 (1995-96). That is more than twice the amount of the country in first place (Sweden, 3.5) and puts us in 21st place among industrialized countries. Life expectancy at birth is 76 years (1996) in the United States. That places the United States in 17th place.

Americans lacking health insurance numbered 41.7-million in 1996 or 15.6 percent of the population. In 1976 it was 10.9 percent of our population that lacked insurance. Enrollment in employer-financed health insurance dropped from 97 percent in 1980 to 77 percent in 1995 (full-time employees of medium and large size firms). Of course in the rest of the industrialized world all citizens are covered with health insurance.

As I said earlier, measuring cross-cultural quality is tricky business, but we do have some significant problems when one looks at the comparison between countries. Moving to a single-payer system would not solve all the problems of health care delivery. Single-payer systems have their own set of problems. But when we look at these systems objectively, we find that they are less expensive and tend to produce better aggregate results. Remember we are paying for health care whether we give money to the government in the form of taxes or give it to for-profit insurance companies. The question is who can do it cheaper and ensure good quality, rational health care delivery.

David Shafer, Ph.D. St. Petersburg

Canadian health care works

Re: Low quality and long waits, letter, Aug. 2.

After having read this letter and hearing Dan Quayle in a speech saying that the Canadian health plan does not work, I would like to disagree. After living in Canada for 40 years and being a U.S. citizen for the last 10 years, I can comment with firsthand knowledge.

Yes, I definitely did pay higher taxes in Canada. But yes, I did get my money's worth.

Lower quality care in Canada? Sorry, but I never saw it. I have had times here when I could not afford to go to a doctor. I have seen others who could not afford it either. In Canada, infections did not go untreated, causing further complications.

Another thing _ most Canadian doctors went into medicine to help others and because they wanted to heal, not because they wanted to live the fat-cat life.

I am fed up with hearing people put down the Canadian system when they don't know what they're talking about.

American health care is great for the impoverished or the very rich. We little guys stuck in the middle can't afford it most of the time.

Patricia Flitcraft, Largo

Are blood donor limits the best way?

Re: New blood donation rules bar 6-month U.K. visitors, Aug. 5.

I read with complete dismay and shock the article about the FDA's actions barring blood donors who have spent more than six months cumulatively in the United Kingdom since 1980.

I am not one of those "patriots" from the World War II era who were mentioned as being good blood donors. I am one of those "patriots" who value saving life far more than destroying it. I have given blood regularly since my university days and have relished the thought each time I gave that I was possibly saving a life, somewhere, somehow.

Alas, soon I will donate blood no more. You see, I have committed the sin of having resided in London for nearly one year while on scholarship at the undergraduate level of my studies. When the new rules kick in, no more sore arms and free T-shirts for me.

I guess the truly alarming fact is that this action will cut the already critically low blood supply by reducing the pool of donors by 2 percent! Since I will not be able to do anything else directly in the future, I will be limited to volunteering in another way.

This all raises the question, "Why can't the federal government allocate more money toward finding a cure or a reliable test for the mad cow disease instead of just eliminating everyone like myself from the donor base?"

I want to reassure the readers that donating blood is not a macabre experience. Please consider donating: The journey of a thousand miles begins with one step. Learn what blood type you are. If you are O negative, like myself, you can give to virtually anyone on the planet who needs your help. You will meet some great people at Florida Blood Services, all volunteers. Give life, the greatest gift of all.

Steven Davis, Hudson

Matters of smut and rights

Re: Dear Hollywood, give us a break, by Michele Jacklin, Aug. 2.

The answer to the problem of the smut coming out of Hollywood is so obvious: Congress needs to pass restrictions on what can be produced and distributed to the public, especially young people. We have laws that govern all kinds of things that can be sold to children _ things like guns, alcohol and tobacco. We outlaw certain types of activities by children such as driving, voting and obtaining medical care without the consent of parent(s), except, of course, abortion.

I do not see a problem with serious limitations on the products the entertainment industry sells to our youth _ and "sell" is the operative word here, not free speech. There is certainly ample evidence that violence in entertainment promotes violence among children. At least, that is what your newspaper tells me frequently.

The First Amendment protects the establishment and practice of religion and freedom of political expression. It does not say one thing about selling smut to children. I defy anyone to produce period writings by the founding fathers that even remotely included the right to make vulgar and pornographic material available to children or adults.

There are those who believe the First Amendment is inviolate. This is a position that cannot be sustained in light of recent activities in Congress. If Congress can pass laws to seriously impair the freedoms laid out in the Second Amendment, then by what logic is the First Amendment protected?

I fully expect that those who support neutering the Second Amendment will simply dismiss my arguments as the ravings of another gun nut. I include the Hollywood establishment, the "free press," including the Times, and other "right-thinking" people just looking out for my safety in this group.

I ask you these questions: What makes you think that one part of the Bill of Rights is more protected than the others? If outlawing certain types of "entertainment" might protect the public from violence, then what is wrong with placing restrictions on the First Amendment? Why is the First Amendment any more deserving of protection than any other part of the Bill of Rights? Why should I support your rights under the First Amendment any more than you support my rights under the Second Amendment?

If we persist in giving up our freedoms in the name of public safety, then the day will come when we are no longer free. When we are no longer free, then we will no longer be safe.

Calvin Elam, Crystal River

Control crime, not guns

Re: Bringing sense to gun control, editorial, July 28.

The strongest and most prevailing instinct in all living things is that of self-preservation. No reasonable person disputes the right of an individual to protect himself and his family from being killed or suffering grave bodily harm.

A corollary of this right is the right of the individual to possess whatever devices or instruments with which he feels most confident to defend himself and his family.

Humans, over time, developed clubs, spears, torches, bows and arrows, knives, swords and eventually guns to protect themselves from predators of all kinds, including other humans. Of course, these devices could be used aggressively.

The only defense against a gun is another gun, preferably with equal or superior firepower. Hence, the law-abiding citizen should be able to own any kind of gun he wants since he will not use it to harm another person except in his own defense.

Gun-control laws impact only the law-abiding. Criminals ignore them. Does anyone have a law that will have the criminals lining up to register their guns?

I bought two new handguns in one day last month. Did I go on a crime spree? No, but I did get up to the gun range to see if I could shoot better with them. (I didn't.) Actually, I traded in two old guns.

From what I read in news reports, the U.S. House of Representatives was willing to pass a law providing instant check (within 24 hours) for sales of guns at gun shows. But the bill was loaded down with amendments for registration, licensing, recording, so that the final result was not acceptable even to many Democrats.

I believe what the public wants is crime control. Gun control is not crime control. The latest figures that I could find show that so-called "assault" weapons were used in about 1 percent of murders in a given year. Probably most of these murders were druggies shooting druggies. While this is bad, taking my guns away from me (which is the admitted goal of gun controllers) will not help that situation.

Fred K. Marchman, New Port Richey

Lance Armstrong offered inspiration

My hero, your hero, our hero!

No one should have a problem defining just what a hero is. If he does, he need look no further than Lance Armstrong.

I was recently diagnosed with aggressive prostate cancer. I opted for radical prostatectomy, but not before this horrible thing got out of my prostate. Needless to say, I was and still am more than upset.

Then along comes Lance Armstrong, and look at what he does. He has given me more than inspiration, and I'm sure many thousands of cancer "survivors" would agree. I will go on now, and I will thank the great heroes like Lance Armstrong. We should all say thank you, because Lance Armstrong is "the man."

John Baldwin, Bradenton

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