A curious letter: beginning with "compassionate care" and ending with "you get what you pay for." Suggesting, it seems, that if Americans want compassionate care they must pay for it.

Although I made no mention of how-or even if-I paid my hospital and the surgeon's bill, Dr. Ganem assumes that I am unwilling to pay for my health care. However, didn't the "Medicare population" pay into Social Security for many years? And weren't their dollars worth more than today's dollars?

But he's right. There has got to be a better way. The Eskimos, they say, once had a cheaper, more effective method for handling the worthless old: They put them on ice floes. This saves paying doctors and hospitals to keep these miserly people alive.

Judging by the response, my article seems to have hit a resonating cord. Dr. Ganem is the only disgruntled reader heard from so far. Doctors tell me that even doctors, when patients, are ill treated. A retired hospital director wrote: "mea culpa."

It has been suggested that perhaps European hospitals are now as bad and expensive as U.S. hospitals. Not so, it would seem. One physician sent me a clipping from The New York Times, a letter to the editor by a man who shopped around for his ureterolithotomy. The lowest price he could find in the United States was $12 000 for surgery and 4 days in the hospital. He went to Rouen, France, where he had excellent surgery and spent 7 days in the hospital for $2000.

A friend of mine who lives part time in France tells me that she recently had an appendectomy there for $1800 and enjoyed wine with excellent meals in a lovely room overlooking a pretty green courtyard. She contrasted this with her earlier treatment in a New York hospital where, when a rash developed on her back, she was handed a tube of Vaseline and told to apply it herself.

Are old people alone responsible for the "progressive bastardization of health care"? Don't doctors and nurses have something to do with the quality of health care? Are they interested? In the most recent issue of American Scholar, Dr. Paul R. McHugh at Johns Hopkins writes that "the aim of medicine cannot simply be to prevent suffering. ... The elimination of suffering is a veterinarian rather than a medical goal." That seems, as the young say, way harsh. Perhaps an ice floe isn't all that bad.