In his optimistic fervor for the administration's National Security Act, Dr. Schroeder [1] conveniently ignores the flaws that will lead to health care rationing.

As a practicing internist, my greatest concern is for my patients' well-being. Many of my patients have expressed concern that eliminating obstacles to care for the uninsured and underinsured may create more formidable obstacles for those 80% of Americans currently satisfied with their medical care. My patients tell me that it is not their medical care that needs reform, but the medical insurance industry.

Medical insurance companies skim up to 23% of premium dollars for marketing and other internal issues and profit; this money does not produce one iota of patient care.

Reform of this unfair practice alone could go a long way toward insuring our currently uninsured. Insurance companies do not need to operate at an overhead 10 to 20 times that of federally mandated programs. Community rating is an inappropriate tradeoff for continued skimming.

Dr. Schroeder is right about the potential hazards for clinicians in this plan. Legal prohibition of boycotts to participation in the plan will suspend the civil rights of physicians and is intolerable in a free society.

The public is demanding insurance reform, not medical practice reform. Rationing is unacceptable, even to achieve universal health care coverage.