Mailbag:

We think it is a swell idea to have a water taxi service in Newport Harbor (“Are water taxis on their way?,” Friday).

Hopefully, the powers that be can strike a balance between the needs of us residents and tourists.

We would take it to church, the library, restaurants and our favorite destination, the Fun Zone.

ANN AND SCOTT WILLIAMS

Newport Beach

Health care has devolved over time

I have been a medical doctor for 38 years, a longtime Republican and a dermatologist in Huntington Beach for 32 years.

I support President Obama’s health-care plan, especially the public insurance option (“Locals decry health plan,” Aug. 5).

Over the past 38 years, I have seen the gamut of health-care options, including the transition from private insurance plans to the HMOs (health maintenance organizations) and the IPAs (independent practice associations), which now account for a large part of the health-care bureaucracy.

These organizations act as intermediaries for the insurance companies, often restricting access to specialists and limiting payments to doctors, especially to specialists such as dermatologists.

It has been an interesting experience to see how the HMOs and IPAs have progressively restricted access and medications, while increasing the rates people have to pay and lowering the payments to doctors, worse than government plans such as MediCare or MediCal.

The insurance companies have enabled the HMOs and IPAs to run interference for them, so that there are now two layers of bureaucrats that exist between the health-care dollar and the health-care provider, thus lowering the payment to doctors because two sets of administrators have to be paid: the insurance company and the HMO or IPA that manages the payments to the doctors.

People might not realize that their insurance plan is not what sets policy for physician access or payment, but it’s the HMO and IPA that set policy. Some of these plans are paying 70% of MediCare rates and are not allowing certain skin conditions to be treated by dermatologists.

Instead, the skin conditions are supposed to be treated by the primary care physician, who has less than ideal education and experience in managing skin problems. Even at that, in the case of a prominent IPA, if a referral is made to the specialist, that specialist has to completely take care of the problem in one low-paying office visit. No payment for follow-up visits, no payment for biopsies, freezings, diagnostic tests, etc. I call this the “dumbing down” of medical care, which is a sad commentary on how the health-care system has devolved in the United States.

If you really care about what’s the best health-care option for yourself and for the American people, support the Obama plan, especially the public insurance option. This public insurance option is only an option, an option that can be chosen by individual people, or it may not be chosen, if you so desire. You certainly have the option of continuing to pay the high insurance rates and restricted access of the private insurance plans and their surrogates like the HMO and IPA. The choice is yours. However, if Obama’s public health-care plan fails to pass due to insurance-company lobbying and a misinformed public, expect the current policies of higher premiums with lower services to continue.

JAN D. VANDERSLOOT

Newport Beach