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A way to contain health care costs

Regarding the article "No `Right' to Health Care," June 28: Many other nations believe that health care for their citizens is a right and have acted on that belief. In fact, nations that provide health care as a right have contained the cost of the care much more successfully than the United States.

For example, from 1960 to 1990 health expenditures as a percent of gross domestic product increased from 3.9 percent to 6.2 percent for Britain, from 4.8 percent to 8.1 percent from West Germany, and from 5.5 percent to 9.0 percent for Canada. Compare these statistics to an increase from 5.2 percent to 12.4 percent for the US.

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There are no data to suggest that citizens in these other countries receive care inferior to that given here.

In fact, data for 1988 show that these nations have lower infant mortality rates and longer life expectancies.

From this, we can see that blaming the American consumer of health care for the spiraling cost of the US system is specious. A more plausible, but only partial, explanation for the spiraling cost of care is that a majority of US physicians provide care under a fee-for-service system. This provides an incentive for the physician to overtreat and to overcharge for the treatment.

A better payment system is the capitation system with salaried physicians, which eliminates the incentive to overtreat and overcharge while still safeguarding the health of the patient.

Under capitation, both the physician and the system are responsible for the care of the patient throughout the patient's lifetime. Hence, there is a strong motivation to encourage preventive care and to provide care when it is needed. Ronald Forthofer, Longmont Colo.

Letters are welcome. Only a selection can be published, subject to condensation, and none acknowledged. Please fax letters to (617) 450-2317 or address them to "Readers Write," One Norway St., Boston, MA 02115.

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