To the editor:

Vermonters have given us all appropriate and welcome leadership in recent weeks. At town meetings in many Vermont communities there were "petition articles" on the town warrant. One, which slipped under the media radar screen, called on the Vermont Legislature to enact a Universal Single Payer Health Care Plan, which would cover every citizen in Vermont.

Nationwide, the need for such a health care plan is obvious. Our per capita expenditure on medical care is by far the highest in the world. For that outlay we achieve the 37th place rating in life expectancy and the 42nd in infant mortality rate (IMR). The IMR is generally regarded as a sensitive index of any nation's quality of caring and sense of responsibility for its population. We have dropped from 23rd at the time of the first Gulf War to our present dismal level. I am soon to retire after 45 years as a family doctor in Westport. I have seen at first hand the transition from medicine as a profession to medicine as business, from medicine as caring toward medicine as paperwork.

During the Vermont debates on this issue, our grandchildren's pediatrician, Jack Mayer, wrote an eloquent letter to his local newspaper. With his written permission I quote him:

" ... I am seeing more and more uninsured children in my practice. Kids don't decide to be born into a rich or poor family. They don't decide to be born with asthma or allergies or ear infections. Health care for children should be a right, not a commodity. Every other industrialized country guarantees health care to all its citizens. We have a very good health care system, if you can afford it. The free market cannot provide equity care nor has it kept the cost of health care down.

"Fully one-third of health care costs are administrative. I deal with over 100 insurances in my practice. That's not health care — that's bookkeeping. The U.S. has an infant mortality rate that is worse than 41 other countries, including Cuba and China. That's not health care—that's shameful.

"In a recent survey of Massachusetts physicians, the majority were in favor of a single-payer, national health care insurance system. More and more business are clamoring for universal health insurance because the cost of private health care is breaking their budgets. And finally, it's just the right thing to do. People shouldn't have to look in their wallets before deciding to see their doctor. Our legislators need to hear the voice of sanity and compassion."

Part of my practice has been as a mentor in the Family Practice Department at Brown University Medical School. I have precepted many young medical students and seen in them the same idealism that led me to apply to medical school 60 years ago. Whether those ideals will endure the onslaught of intrusive insurance companies and so called H.M.O.'s remains to be seen. The valued traditional doctor/patient relationship is in jeopardy.

I hope for a brighter future for American medicine, especially for the patient. Perhaps the compassionate "sea change" advocated by the citizens of one of our least populated states will become reality, raising a standard to which all may be drawn.

Dr. Stewart Kirkaldy

Westport