Letters

By , M.D and H. William Batt, PhD

Air Travel Subject to User Fees, Not Taxes

In "Taxes May Mean Less-Frequent Fliers" (July 11) the author does his readers a disservice by making reference to the proposed "taxes" on airline tickets. Even though many of our political leaders also have made this mistake - and indeed may have been responsible for the distortion in the article - these are really "user fees," levied according to a person's use of the service, just as someone would pay for parking his or her car at a meter.

User fees are intended to recover the costs and pay for the benefit of one's use of what is partially, perhaps even largely, a private good of consumption. Taxes, in contrast, are levied according to one's ability to pay and are intended to support general government services.

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Some people consider user fees a sub-category of taxes, but, regardless, it is important to make the distinction if we are to foster efficiencies as well as equities in tax design. Just as "gas taxes" are user fees understood to pay for the use of the roads, air-ticket fees are supportive of airport services.

H. William Batt, PhD

Albany, N.Y.

Executive Director

Central Research Group, Inc.

Regulation of health care

I am writing in response to the biased opinion article "Address Quality Issue in Health Care Industry" (June 30). The author's perspective is tragically naive.

The author makes a comparison between the airline industry and health care delivery, suggesting that the federal government is able to monitor and control quality within the airline industry and therefore should impose similar oversight to the health care delivery system. In reality, there is no similarity.

It is true that pilots, air controllers, and other key workers within the airline industry are responsible for the safety and lives of numerous individuals and are indeed highly trained and skilled in their practices. But these practices do not change on a daily basis, and monitoring the functions of individuals within the system and their outcomes is quite simple: An outcome is either a successful flight or an unsuccessful flight.

The health care industry is so much more complex, with changing demands, that no reasonable comparison should be made. Thousands of peer-reviewed research and clinical papers are currently published on a monthly basis. The changes that are occurring in terms of the proper and optimal management of the care given any single individual is different from one week to the next, and the idea that some simplistic governmental dictate could possibly oversee this system is ludicrous.

The author says "the dirty little secret of the world's best health care system is that it is operating in a quality control vacuum with no universal guidelines for procedures or practices." This is not only inaccurate, but it also reflects his lack of knowledge. If serious guidelines were dictated by the government, progress in medical care research and outcomes would be impossible, since all participating health care providers would be required to abide by standards that are rapidly becoming archaic.

The author is quite right when he states, "Today there are no commonly accepted parameters for determining which procedures provide the greatest benefit at the lowest cost." It is for exactly this reason that no firm guidelines can or should be established.

We can only progress and improve if research can be applied to the delivery of health care, and this, of course, means the continuous changing of guidelines.

I am afraid the author would not be very proud of the health care system that he envisions. It would be analogous to any governmentally planned and controlled social system - none of which have been successful to my knowledge and certainly not within a system as complex or important to our citizens as health care.

Robert L. Katz, M.D.

Solon, Ohio

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