I read with interest the letter by Dr. Scott Mendelson, M.D., Ph.D., in the December 19, 2003, issue. He reported his disgust with the news that an HMO merger will lead to one of the CEOs’ pocketing "nearly $335 million in the deal," when certainly this money could have gone a long way toward alleviating the pain and suffering of their subscribers. He pointed out that the HMOs make life miserable for practitioners by making it difficult to prescribe medications and collect monies due them.

All this is true, but I do not agree with his conclusion that "[w]e need a single-payer system." If there can be greed, dishonesty, poor allocation of resources, poor insight, and lack of foresight in big groups, why should we think that a single-payer system would be any better? Perhaps it is hope: we hope, we wish, we want to believe that there is a single-payer system out there to make all of these headaches go away. I don’t believe it, however. I think there will be just as many headaches, and probably more, under a single-payer system—headaches that are hard to imagine right now.

What about a return to a more realistic look at our world? Excellent health care costs more. Instead of using HMOs in which the likes of $335 million is siphoned out of the system, what about some other method of allocating health care dollars? Perhaps the money should simply be put into investment accounts like medical savings accounts, which can be used only for specific health care costs but are in the hands of either the individual or a company medical benefits division. Surely we can think of other ways to deal with this problem rather than counting on a fantasy of how we would like the system to be easy, fair, and always funded.