I read with great interest Christopher Conover’s March 19 column “How US health care truly stacks up,” in which cost and effectiveness were addressed. The third aspect, accessibility, was not addressed. Arguably, it may not be independently relevant to the extent it is reflected in the other two considerations. Still, it is strongly dealt with in the Patient Protection and Affordable Health Care Act of 2010.

In comparing costs between the U.S. and other countries, there are some other aspects of costs that may be handled differently and may differ significantly in amount and which were not addressed in the column. The cost of the education of health care workers is a legitimate cost of health care but is more greatly subsidized in other countries where education is mostly paid for by general taxation rather than by tuition and fees paid for or by the student in the U.S.

Professional liability exists to some extent in all countries but, for example, in Germany — vis-à-vis the U.S. — the loser in tort cases pays the court costs of the winner and judges rather than juries determine the verdicts and with fewer astronomical awards. The professional liability insurance premiums are, therefore, much lower in Germany than in the U.S. Incidentally but importantly, this situation has a direct impact on accessibility. For example, family doctors who could provide obstetrical services in small towns might not because they cannot afford the liability premiums.

My point is that if these additional factors are taken into account, the cost of American health care could well be less expensive than in other developed nations.

Dr. (Col.) Frank Leitnaker (retired)

Bruchmühlbach-Miesau, Germany

Landstuhl helped in many ways

This is a note of thanks to the entire medical staff of Landstuhl Regional Medical Center, Germany. My 46-year-old wife courageously battled cancer there for eight months before losing her fight on March 12, 2012.

During this time, LRMC unfortunately became a dominant part of our daily lives. While the outcome was not what any of us had hoped for, I would be remiss in hindsight in not thanking a group of individuals at LRMC who made that journey less painful. First, to Dr. (Col.) Moore, our surgeon, who performed two remarkable life-prolonging surgeries during those eight months: Without your individual skill and talent, we would not have had that time for our families to gather and say goodbye. I would also be remiss if I did not thank the surgical recovery ward (Ward 8) staff for assisting our family on three separate occasions during this time and in making her medical recoveries as smooth as possible.

Second, to Drs. Carmichael and Harris of the oncology department and their clinic staff (Joan, Andrea, Beth, Corey and Annalee), who did everything they could to make her weekly chemo sessions more tolerable and in distracting her from the ever-increasing pain and discomfort that accompanied the deadly progress of her cancer. While my wife often voiced her displeasure with chemo and its side effects, she simply adored the LRMC oncology staff and invited some of them to celebrate the Christmas holiday with our family.

Third, to Allye Doolittle, who greatly assisted and provided advice to our family during those final moments: Without your advice, I think those final moments would have been disturbingly overwhelming and chaotic. Thank you in preparing us for one of the most difficult mission of our lives — saying goodbye to her in a compassionate and loving way.

Gary Masapollo

Kaiserslautern, Germany

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