Federal Limits on HMOs’ Policies

“Preserving an Essential Balance of Conflict” (editorial, Dec. 27) stated that the federal government will limit but not ban bonuses paid to some HMO doctors for controlling costs. This was, the editorial further stated, being done to protect medical quality of care. It went on to comment that the rationing of medical care was cold but it is the only pragmatic way of addressing HMOs’ inherent conflict of interest.

I totally disagree. Something is either right or it is wrong! The patient either needs referral to a specialist or he or she doesn’t.

The persistence in giving bonuses to HMO doctors, no matter how small the percentage of pay, is unethical, unwise and fraught with inherent dangers in the proper treatment of a patient. A conscientious doctor who thoroughly examines a patient and feels there is a need for consultation by a specialist should have the freedom to refer--bonuses or not!

Let us never forget that the HMO style of vending medical care is based upon a bad medical premise in the first place. The least done for the patients, the more money kept in the HMOs’ coffers.

FLOYD A. NASSIF MD

Glendale

* Re Robert Kuttner’s “Putting an End to HMO Bribes, Gags and Denials,” Column Left, Dec. 29:

In the World Book Dictionary a bribe is defined as: “Money or other reward given or offered to get someone to do something he thinks it is wrong to do.”

Kuttner insults me and every other physician who treats patients who are insured by HMOs. A bonus, not a bribe, is given for providing good and cost-effective care. Necessary care is not withheld, as suggested by Kuttner.

He feels that the “best approach” for medical delivery in this country is to salary physicians. I don’t know what medical background gives him the authority to say this, but maybe he has been “bribed” by his employer to promote a socialistic agenda when writing Column Left articles for The Times.

FRED L. LIEBERMAN MD

Los Angeles