I have a big clip file on Gov. Lamm, and it is interesting that after years of inactivity he is again resurfacing as a media darling, along with an increase in doctor bashing stories, now that health care premiums are on the way up in double digit fashion. Managed care has failed, or to be more precise, the shifting of risk from Corporate America to HMOs to doctor-run managed care entities has failed, so now the blame game starts. Lamm is not "moral;" he's a self-serving politician who wants to set limits without a public discussion. He wants others to die sooner than necessary, and like all other members of the political class, and the rich, he knows he will be able to get to the special clinics that will offer the kind of care he and his ilk deserve. That's what happened in the former Soviet Union, where communist leaders had their own clinics with high tech medical equipment that the masses could never use.
I have helped lead a community wide discussion in San Diego 4 years ago that tried to get citizens to set limits and priorities. It was a difficult process. I see no political leaders at either the state or national level who are willing to risk their political careers to take on this process. Politicians like Lamm will always cater to the big corporations and contributors when fashioning their rationing plans. That's what gave us HMOs, and Lamm offers no plan to avert this dismal political future. As for doctors, they have a duty to care for patients one patient at a time. Letting people die to give some HMO executive more pay and more stock options is a process that is unconscionable. Lamm isn't saying anything that a lot of us haven't been saying for years. But his glib advocacy of rationing without the consent or knowledge of the people has always been hard to swallow. He doesn't really believe in democracy. He believes in annointing a political class to decide who lives and who dies according to the whims of their corporate patrons.

Brant S. Mittler,M.D., J.D.
San Antonio, Texas