I THANK Dr. Marcia Angell for her May 23 op-ed "Held hostage by the health system." She is right that the single-payer, government-run health systems in most advanced countries are far better than our largely profit-oriented system. But I oppose her idea, and that of Representative John Conyers, of extending Medicare to everyone. The health insurance businesses are already there, and only need to be strictly regulated. This means their wages must be limited and kept in line with government wages, and they must be unable to refuse service to anyone who applies, however sick he or she may be.
Such rules would force them to use fewer expensive tests and intrusive procedures. They would also force them to pay doctors less, but to give more business to primary care doctors. Finally, it would reduce their use of hospitals, which often cause the spread of viral and bacterial illnesses among patients.
True, the stocks of many health insurers would fall. But they might come back. And if some went bankrupt, they could still remain in business (just as Chrysler will). Pressuring their stocks is far fairer than simply putting them out of business by extending Medicare to all.
William E. Stoneman
Dedham
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