This is the text of a letter recently sent to Kathleen Sebelius, secretary of health and human services in the Obama administration.

Dear Secretary Sebelius,

The availability and cost of health-care insurance has certainly become a critical issue in the lives and minds of the citizens of our country. I feel that it is important that you hear from those who are "in the trenches" -- the people actually providing heath-care services.

It is my belief that we have a health-care insurance crisis rather than a health-care crisis per se. It is also my belief that ultimately we need to get health-care insurance off Wall Street.

Mandating that all insurance carriers sell their stock and become not-for-profit companies would allow competitive forces to continue to function in the marketplace and allow the private sector, rather than a state or federal government entity, to administer the operations. It is my belief that the private sector is very capable of running efficient insurance companies, but those companies cannot serve the best interests of their insured clients and their stockholders at the same time.

State insurance commissioners and federal oversight to ensure that these companies behave in a not-for-profit manner would protect the interests of the American public. This change would shift enormous amounts of capital from investors directly into health-care delivery, allowing greater health-care access, more affordable health-care coverage and more expansive health-care benefits.

Health-care insurance companies do not need venture capital, and there are hundreds of other investment options for investors. At a time when the costs of health care are rapidly rising, does it make sense to spend significant health-care dollars to pay "middle men" expenses to insurance companies and their shareholders rather than spend these dollars for health-care services that directly impact the lives of the citizenry?

As we both know, however, the health-insurance lobby is powerful and influential. This type of change would require real political courage and commitment from our elected officials to become a reality.

This proposal represents a significant change from the system we now have. The reality, however, is that the health insurance system that worked in the past no longer works for the American public.

Patching the current system has not fixed the problem in the past, nor will it fix the problem in the future if it does not directly and dramatically effect the allocation of increasingly scarce financial resources for health care.

I will be happy to discuss this issue with you or your representatives if you wish to do so.

Michael J. Bartiss, OD, MD, lives in Pinehurst and can be contacted at kidseyes@earthlink.net.