Baltimore's Health Care Model


President Bush's proclamation that the East Baltimore Medical Center is a model for the country in containing health care costs is clear evidence the administration wants to tap into the prestige of the Johns Hopkins Hospital in dealing with this high-cost issue. Its formula calls for Medicaid patients to be enrolled in health maintenance organizations (HMOs) where, as at EBMC, they receive the same care as privately financed patients.

The East Baltimore facility is one of 18 now operated by the Prudential Health Care Plan in cooperation with the Johns Hopkins Medical Services Corp. Its genesis goes back 25 years when Hopkins officials met with community leaders to discuss tensions in their immediate neighborhood. Out of this came a plan launched by former Mayor Clarence "Du" Burns, then a councilman, that embraced the idea of providing complete health care for one flat fee. When the community could not support the insurance aspects of an HMO, Hopkins kept the neighborhood's managed care program alive in 1984 by making the center the first site of the Hopkins Health Plan.

All this was recounted to Mr. Bush by Dr. Robert M. Heyssel, president of Hopkins Hospital, when Mr. Bush visited the center yesterday and later spoke at nearby Dunbar High School. "Unlike other HMOs," said Dr. Heyssel, "we did not turn our back on the men, women and children on Medicaid." He praised state of Maryland officials for gaining a federal waiver to require Medicaid recipients to enroll in an HMO rather than rely on sporadic and more costly visits to hospital emergency rooms.

The administration approach has been criticized by some Democratic members of Congress who question the quality of care that might be given to Medicaid HMO patients. But Dr. Heyssel made it clear he thinks this is the way to go.

Mr. Bush, in turn, called the East Baltimore program just "terrific" -- an approach the rest of the country should emulate. He complained that the rival Democratic "pay or play" plan to provide universal health insurance coverage would put Congress the role of fixing health-care costs and interjecting the government between patient and health care provider. But he also said key Democrats advocate reforms similar to his.

There still is room for blending various schemes for reducing health care costs and providing insurance and adequate care to all citizens. It just won't happen in an election year when both parties try to play the issue to their own advantage.

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