I read with interest HHS Secretary Mike Leavitt’s editorial in your publication titled, “Affordable health insurance for all Americans” (special section, “Healthcare,” March 28). It is hard not to conclude that Mr. Leavitt has a superficial view of the healthcare enterprise. What he posits is what we’ve heard from government and private interests for decades — private markets can do a better job than government in meeting the healthcare needs of the nation’s citizens.

If that were the case, why has healthcare inflation outpaced GDP growth for the past four decades? And why are so many left out of coverage, and why does quality suffer?

What Mr. Leavitt fails to understand is this: It is the private market itself that is inefficient, and that has produced the uninsured and quality problems. ...

The payer market is made up of government payers, Blue Cross, national insurers (like Aetna), regional health plans and PPOs. The health provider markets consist of hospital systems, thousands of physicians in solo practices or large groups, hundreds of ancillary providers (home health, skilled nursing) and others. Considering this simplified description you can see the utter futility of trying to make private markets work in the way they are fashioned.

Each large employer has a unique benefit plan, a unique population and each one requires unique administrative support, set-up and on-going maintenance. Each insurance company or health plan has unique systems, customer support lines and policies and procedures. This fragmentation and specialization is expensive.  (I know. I work for a health plan.) Some estimates put providers’ administrative costs at 30 percent. I think it’s actually higher.

It doesn’t end there. With risk fragmentation there is little or no way to manage populations across disease states. Thus diabetes is managed differently depending upon the provider or the health plan. In today’s private markets, developing standardized care across disease entities is impossible, and thus the enormous variation. This is what the private market has wrought, and it lacks the mechanisms and the structure to change. ...

People like Mr. Leavitt need to do some homework and think more deeply about this problem than he has done to date. ...

Grand Rapids, Mich.

WEBB AND WEAPONS

Irresponsible

From David L. Baker

I am a Florida resident and possess a concealed-weapon/firearm license in that state.
A relevant point regarding the incident with Senator Webb’s weapon is this: Those who are licensed to carry deadly weapons are burdened with the responsibility to insure that the weapon is reasonably inaccessible to others whenever it is not under the direct control of the licensee, especially when it is loaded.
Responsibility is 24/7.

Montverde, Fla.

An imposter?

From Brian Perkins Sr.

A loaded gun and two extra clips? Are we really sure Webb was a Marine? Most of us would need only one or two rounds to deal with any imaginable threat. Could this guy be an imposter?

Fort Worth, Texas