RE "MAKE doctors agents of health cost controls" (Op-ed, July 21): I cannot imagine a scenario more burdened with moral hazard and potential conflicts of interest.
Alan Sager and Deborah Socolar propose "professionals" accepting capitation payments calibrated to patients "health." Who is to do this calibrating, and how will it be adjusted as circumstances change? The authors may not realize that capitation was all the rage about 15 years ago (Secure Horizons and other plans). We discovered then that pitting generalists against specialists brought a lot of ill will for very little gain. Financial risk management is the business of insurance companies, not doctors. It should be no surprise that it quickly became apparent that physicians, even with managerial help, were not very good at it.
Turning every doctor's office into a mini-insurance company with a risk pool of a few thousand patients was and is ludicrous. The best way to "spend only what is affordable" is to put patients in charge of the money. Only they have real-world incentives to avoid waste and duplication, as it is their own money they would be safe-guarding it. Any system that is based on the premise that they are too stupid to do this (such as the one we have now) is bound to fail.
BERNHARD HEERSINK
Newburyport
The writer is an ophthalmologist.
