In the real world, I am sorry to say, the cost to public health of the broadening scope of procedures, equipment and services cannot continue to be borne by current funding.

While the points raised in "What premiers could do for health care" (Jan. 15) on pharmaceuticals and their costs are well taken, I am sorry to say my experience of nurses "putting the patient first" are not so.

This was the case when I first started out in practice in the early 1970s but over the past 20 years I have seen that eroded to putting the paperwork, coffee break or lunch break before the patient.

Nursing services these days both in Canada and the United States are long on administration and short on patient care. Patients wait longer and longer for personal assistance when needed, their pain and suffering and personal needs becoming an inconvenience rather than a primary necessity.

Physicians bear some blame here also. We have forgotten to put the patient first. I used to tell my staff not so long ago to "put the patients first, and finance and other matters would take care of themselves."

Having practised in both the United States and Canada in both office and hospital settings, I cannot see how we can continue to afford the care we aspire to, using the "universal health care" model.

Those of us who can afford to do so should be asked to bear a greater share of of the cost, while those who can least afford it should bear a lesser share.

A "dual system" might be the lesser of all evils. It would relieve the "public" health-care system of congestion and cost.

It should also be required that all physicians provide services to both systems and not just the self-pay or assisted-pay system. A uniform plan should also be in place to audit both systems to ensure that both systems provide appropriate and acceptable levels of care.

Emphasis on primary care and preventive care is imperative to minimize costs by preventing disease or injury. Life choices such as smoking and diet are a major source of cost to the system. These issues must be addressed by all means possible.

Money spent here is well invested. I realize that in this country we are loathe to look at what we fear will be a "two-tier-system." I am very afraid that we really have no choice, unless we are prepared for very high taxation to cover the inevitable growing costs.

Dr. Martin Rodgers, M.D., has retired to the Malahat.