John R. Graham in "The Health Cost Myth" (op-ed, Nov. 13) sees no problem with our rising health costs because our economic productivity is very high and, after paying for health care, we still have on average more money left per capita in our economy than other countries.

This spurious argument ignores these facts: Rising health costs currently threaten to bankrupt the U.S. Treasury, according to the Congressional Budget Office. The CEOs of some of our largest businesses are saying the same thing about their companies. Public spending on health care is rising faster than GDP, so spending on other essential public needs must be reduced or taxes increased. Most health-care spending is not discretionary, but is dictated by illness and injury and by the decisions of providers and insurers who profit from a system in which price-competition cannot function as it does in other parts of our economy. Finally, as Mr. Graham acknowledges, "averages obscure many harsh realities and hide the fact that many Americans are unable to afford health care." Further, the numbers of uninsured and underinsured continue to rise as health costs increase.

The health cost crisis is not a "myth."

Arnold S. Relman, M.D.
Harvard Medical School
Boston

In response to Mr. Graham's commentary, I feel compelled to point out that the author assumes that the rationale behind universal health care is cost containment. Mr. Graham misses the point. The people advocating universal health care are addressing the lack of access to care, something the author only acknowledges is a flaw of the current system at the end of the article. It is a terrible shame that this country manages to spend vast sums more on health care than other countries it competes with, yet still leaves 15% of the population without health insurance. Our system may allow some workers to take home a bigger piece of the pie, but it strikes me as immoral to make profits (and celebrate this, as Mr. Graham does) at the expense of our fellow Americans' health.

Hillary J. Mull
Doctoral Candidate
Boston University School
of Public Health
Boston

Mr. Graham makes some good points but he omits some significant additional costs to the "underpaid" workers of Europe.

Their health care isn't "free"; they pay 7% to 17% of their income in taxes to support their health care system.

They pay, in most cases, an income tax which averages 5% higher than that imposed on American workers with the same base pay. Additional levies in Europe make doing the calculation on the basis of adjusted gross income very difficult.

They all pay an extremely regressive "value added tax" on most consumption, at rates between 15% and 22.5%.

Americans who say they don't earn enough to pay for their health care but seem to afford SUVs, soccer camps, and second homes really aren't paying attention as to how they spend their "disposable" income.

Paul Wisgerhof
Fairfax, Va.