[Regarding Mother Jones’s article, “The Big Idea,” May/June], if there were ever a need for a pragmatic approach, we need it now to reform our health-care system. The biggest threat to achieving a consensus on health-care reform is adherence to strict theology. Hillary Clinton is leading a task force that is meticulously searching for real-life solutions.

President Clinton has offered an overall framework for reform, combining the market-oriented idea of “managed competition” with strict budget discipline.

Managed competition is designed to reverse the current balance of power. Now, insurance companies have the luxury of picking and choosing whom they will cover, rejecting the people who need insurance most, and offering others outlandish rates. The Clinton proposal would bring consumers together into large purchasing pools, forcing insurers to compete fiercely for business or lose huge blocks of customers. Buyers, instead of sellers, will drive decisions about prices, services, and quality.

But let us be mindful that health reform is not about building some new machine that is perfect down to the last rivet. It is not art– function rather than beauty must be our measure. If it works–however inelegantly–it will be a vast improvement over the present system, and adjustments can be made after the major legislation has passed.

Robert Dreyfuss replies: Senator Rockefeller wants to warn us against “adherence to strict theology.” Although he does not say so, presumably the object of idol worship to be avoided is the Canadian model of health-care reform. In fact, it is the senator from West Virginia who is enthralled by belief in the supernatural, because his favored approach to health-care reform, namely, “managed competition,” exists nowhere but in the prayer books of the insurance-industry- funded Jackson Hole think tank that invented it. Because managed competition does not exist in the real world, to believe in it requires an act of theological faith that most of us are incapable of.

Senator Rockefeller says that managed competition would force insurers “to compete fiercely for business”–and that is exactly the problem. The easiest way to make profits is to avoid enrolling sick people in health plans, and so insurers would compete with each other to recruit healthy people. No known regulatory system can prevent insurers from using a thousand marketing tricks to that end. And layering hundreds of thousands of insurance company bureaucrats on top of the health- care delivery system will add enormous, unnecessary costs to the mix. Further, under financial pressure, insurers will favor using second- rate medical devices and drugs. Consumers, forced into such HMO-style health plans, will likely find health care to be a nightmare.

Of course, Mr. Rockefeller will probably continue to use his family doctor.

BILL OF HEALTH

I thought your readers would want to know about the single-payer legislation I have introduced, for the second time, in the U.S. Senate. The American Health Security Act, S.491, is the leading proposal for just the kind of universal, affordable, comprehensive, and equitably financed health-care system your chart described.

I hope that supporters of the single- payer proposal will use our work on S.491 in lobbying their members of Congress. I would be glad to send a summary of the bill to all who write and request it. In addition, Citizen Action is organizing support for the bill in thirty-two states, and can be reached at 1120 19th St. N.W. #630, Washington, DC 20036, 202-775-1580, to locate local chapters.

TO YOUR HEALTH

I’m sending my copy to my primary care doctor (whose specialty is “family medicine”), with whom I had an appointment yesterday for my annual checkup, and with whom I have had a continuing conversation about the U.S. health-care system (what system?). In his spare time (hah!) I’m sure he’ll read it.

CANADIANS DO IT BETTER

Last year, my father nearly died from a painkiller prescribed to him when he went to the emergency room. The severe allergic reaction, which kept him in a coma and on full life-support systems for three weeks, required numerous blood transfusions, many sessions of kidney dialysis, copious intravenous medicines, a tracheostomy, and round- the-clock intensive care. He had his own room for this entire time, and reposed on a specially designed therapeutic air mattress that alone cost three hundred dollars a day to rent.

The only bill presented to him was a clean bill of health. As an artist, he could never have afforded that care had he been in the U.S., but the real cherry on top of this story comes in with the new premium scales in our province. When I went to pay my own yearly health insurance premium (about twenty-four dollars), I was told that as of July, my medical insurance (and my father’s) would be premium-free. Yes. Free.

Perhaps someone should tell President Clinton that.

SUNSCREENS AND CANCER

There is no scientific evidence to prove the story’s central contention that sunscreen use may increase rather than decrease the risk of malignant melanoma, a deadly skin cancer. However, there is a great deal of evidence that sunscreens do help protect against skin cancer, as well as against sun-induced damage to the skin, including sunburn and premature aging.

Your article also made some misleading implications about the Skin Cancer Foundation’s Seal of Recommendation. Corporate sponsorship provides about one-fourth of the funding for this and other educational programs, while the rest comes through a combination of private donations, foundation grants, and fund-raising events.

Sunscreens that carry the seal on the label have met stringent criteria developed by our Photobiology Committee, which is staffed by experts on the effects of solar radiation. The criteria in some ways exceed those of the FDA.

A RAISIN IN THE SUN

To quote that statement: “The dermatological associations are concerned about the potential damage the publicity given to the theory of the Garlands could do to worldwide cancer prevention initiatives.” The statement concludes: “The best thing that any individual can do to prevent skin cancer is to practice sun avoidance. Dermatologists around the world recommend keeping out of the sun in the middle of the day, wearing appropriate clothing and hats, and applying, on uncovered skin, a sunscreen of at least 15 SPF.”

We will be glad to provide your readers with the complete statement if they write to us.

Michael Castleman replies: The American Academy of Dermatology and the Skin Cancer Foundation maintain that sunscreens block “large amounts” of UVA, that the case against sunscreens is unproven, and that questioning the value of sunscreens might cause Americans to take fewer sun precautions.

The vast majority of sunscreens do not block “large amounts” of UVA. They block only one-third of it, according to a 1987 report in the AAD’s own Journal of the American Academy of Dermatology. Two-thirds of UVA goes right through sunscreens, penetrating down to the pigment-producing cells that turn cancerous in melanoma.

Recently the FDA approved the UVA-screening chemical Parsol 1789. UVA protection is sure to be the next big focus of sunscreen marketing efforts. Maybe blocking UVA will prevent melanoma. No one knows.

The article stated many times that the case against sunscreens is unproven and widely disputed. There is no animal model for melanoma, so no one knows what causes it. But the case for sunscreens is equally unproven. The argument here is not between revealed truth and an unproven theory. It’s an argument between two unproven theories.

As to the AAD’s and SCF’s fear that by questioning the value of sunscreens, the article may “cause the public to stop taking sun protection precautions,” I doubt it. Instead of simply relying on sunscreens, Mother Jones‘s readers were advised to protect themselves the way people did all of fifty years ago, when no one used sunscreens and when melanoma was extremely rare–by refraining from sunbathing, by wearing protective clothing, and by practicing prudent sun avoidance.

Anyone interested in the thirty studies on which the article was based can send eight dollars to Mother Jones.

BURNING ISSUE

My only consolation for being hopelessly out-of-fashion in this skin- conscious age has been that I would not wrinkle as quickly as my beach-worshipping peers and that I would save myself from skin cancer. To this end, I’ve been applying sunblock every day for the past six years.

Well, now I’m pissed. Nowhere before your report have I ever read a news article mentioning that sunscreen has not been proven to prevent skin cancer, and I’m a journalist so I read a lot. It’s also aggravating that few sunscreen makers even attempt to block UVA rays and that no one is doing research into the relationship between sunscreen and malignant melanoma. Furthermore, the correlation between increases in the deadly cancer and sunblock sales is proof enough for me to vow never again to go to a beach or swimming pool without an umbrella and hat: I’ll probably leave my sunblock at home.

You can also be sure that tomorrow I will call my doctor to have my asymmetrical mole examined.

TURNING RED

NEW MEAT IN TOWN

In our extravagant American lifestyle, do we really need to scan the horizon for yet another exotic animal to exploit?

POWER TO THE PEOPLE

Contrary to Sesser’s assertion that “democracy has not made a deep imprint in the countryside,” rural people, in coalition with academics, students, journalists, and more than two hundred grass- roots organizations, have: 1) gained a legal ban on logging; 2) stopped funding for several dam projects; 3) promoted sustainable agriculture; and 4) agitated for community forest preservation.

Social justice groups in the U.S. should support the efforts of rural people in Thailand. Genuine democracy at the community level can help curb the power of the Thai military and other elites and can have a positive effect on the entire region.

CRUELTY-FREE CONSUMING

In Defense of Animals is boycotting Procter & Gamble in an effort to change its policy. We are asking P&G to join with other responsible consumer product manufacturers and end this cruel and needless abuse.

Public awareness of this issue first grew in the area of cosmetics. It is interesting that the companies listed as “Best” in your Makeup/Skin Care list are all cruelty-free.