Author John Steele Gordon’s historical review of medicine up through about 1970 was excellent, and would have been valuable as society decides where to go from here on this complex and emotional issue had he not wandered on into prescribing remedies in an area for which he had obviously not done enough diagnostic work: Mr. Gordon’s prescribed his remedy based on a twenty-year-old diagnosis!

Examples of Mr. Gordon’s blindness to vital newer factors:

He mentions insurance companies and Blue Cross/Blue Shield continually—apparently ignorant that only 6 percent of U.S. employers today still use fully-insured health plans. He does not mention at all that 65 percent of employers today have self-funded health plans sponsored by employers and employee groups such as unions and associations. (The remaining 29 percent are semi-self-funded programs such as “minimum premium” and “experience rated.”) These self-funded plans are a big step toward the ideal Mr. Gordon and I share of personal responsibility.

Mr. Gordon made no mention that there are more than a hundred governmental entities (about fifty in the federal government alone) that issue nearly fifteen hundred new laws, regulations, interpretations, and opinions per year, often counterproductive and conflicting with each other. He also failed to mention that states require nearly eleven hundred “mandated” benefits, including such important things as toupees in one state and hair implants in another.

Finally, Mr. Gordon’s (and my) pet theory of personal responsibility and good consumership on health costs is great for those of us who are responsible and for those too destitute to do anything for themselves. However, experience has shown that the vast majority of Americans between the very poor and the very responsible simply don’t have the will power to save as they should. But what happens when someone spends their money on a fancy car or stereo today and thus doesn’t have money a year from now for medical care for which he should have saved. Do we let him die on the street?