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To the editor: During the early 1980s, when headlines of medical costs spiraling out of control confronted consumers, employers, medical professionals and policymakers, legislation was created that brought competition into the health care market.

As intended, that effort succeeded in controlling health care costs, transforming the face of health care in the United States.

Health care has undergone considerable consolidation, eliminating excess administrative costs. Networks and integrated systems have linked up to increase efficiency and gain market appeal through broader geographic distribution and comprehensive services. Many physicians have joined efforts to find new and better ways to provide high-quality, cost-effective care.

In regions of the United States where the shift from individual physicians and small medical groups toward large provider groups has occurred, and where health maintenance organizations have a strong presence, the cost of health care is demonstrably lower.

This shift has helped to drive waste out of a system where costs were growing at levels that could not be sustained by employer-paid insurance, taxpayer-financed programs and contributions from individuals and families.

Clearly, some of the changes associated with managed care have been controversial. Yet these changes make sense and, in time, patients and health care professionals will adapt.

Take, for example, the routine chest X-ray. In past decades, it was a common practice to order chest X-rays for all middle-aged patients.

The assumption was that routine X-rays would detect lung cancer early enough to allow for surgical removal and elimination of the disease.

But, after years of following this practice, statistics showed that routine chest X-rays did not achieve measurable results. The enormous cost of this routine procedure was certainly making those confirmed free of lung cancer feel better, but it was not providing any meaningful benefit for those patients who had cancer.

The public needs to understand that too much care can be as bad-or worse than-too little.

It also is important to recognize that the decision already has been made: The economy cannot sustain an upward cost spiral, and a return to the past is not an option. The only reasonable solution is for all to work together to ensure both high quality and lower costs are attained.

The move to managed health care since the early 1980s has had-and, frankly, will continue to have-a few bumps in the road. Many of the cases covered in the news are heart-wrenching and often draw substantial media attention.

Although every effort must be made to make further improvements to our health care systems, the improvements should be driven by concerned and educated patients and health care professionals, not headline-grabbing politicians and aggrieved interest groups.

Much of the health care reform legislation being debated in California this summer, for example, falls into the latter category.

Various special-interest groups have introduced legislation in the California Legislature this year that would limit the ability of managed care providers to continue to increase efficiency and quality and further reduce costs. These bills would make it difficult or impossible for provider groups and health plans to discontinue contracts with physicians who refuse to cooperate in developing new health care processes, mandate additional mental health care coverage in areas where no lasting value can be demonstrated, prescribe expensive drugs when an inexpensive one will work as well, increase medical bureaucracy and the cost of medical malpractice litigation.

Unfortunately, what generates far less media attention and no political interest are the hundreds of thousands of Californians and their families who now enjoy excellent health care coverage that once was in serious jeopardy during the days of unmanaged care and annual double-digit medical inflation.

Thoughtful leaders realize that these untold success stories carry much greater weight than the few regrettable stories that seem to capture people's attention. One hopes that legislators will keep this in mind when they are considering costly legislation that would destroy a system that serves the public very well.

Dr. Brian Ely

Rancho Cordova, Calif.

Kuntz mourned

To the editor: Robert E. Kuntz passed away on Aug. 5.

Mr. Kuntz, who was 53, began his career with a brief stay at the Hartford Insurance Co. in Chicago.

He then moved to broker Fred S. James in Chicago, now part of Sedgwick Inc. After nine years, Mr. Kuntz transferred to the firm's Orange County, Calif., office, where he remained until his death.

He was active in the Insurance School of Chicago and the CPCU Society. And, after moving to California, he continued teaching Associate in Risk Management courses within Sedgwick.

Robert E. Kuntz was best known in the industry for his expertise in alternative risk financing techniques and his wealth of technical knowledge.

He will be greatly missed by friends and colleagues.

Laura M. Brugger

Assistant Vp

Andreini & Co.

Irvine, Calif.