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Canadian CareGwinn Owens, in his June 2...

THE BALTIMORE SUN

Canadian Care

Gwinn Owens, in his June 2 Opinion * Commentary article, "First-Hand Facts about Canadian Health Care," accuses critics of Canada's health care system of disseminating a "cascade of misinformation." I suggest that his article does the same.

Mr. Owens writes that Canada's health care bill as a portion of gross national product is 8 percent, compared to 12 percent in the United States. His "apples and oranges" comparison fails to note the significant difference between the two countries that account for higher health costs in the U.S.

For example, the U.S. has a more heterogeneous population and proportionally more senior citizens than Canada. The U.S. also spends more on medical research and development than Canada. When these differences are factored in, studies show that health spending in the two countries is comparable.

Mr. Owens also writes that critics of the Canadian system exaggerate when they speak of the long waits for operations that many Canadians experience. In fact, the evidence suggests that waits are common.

Researchers at the Vancouver-based Fraser Institute calculate the average wait for a coronary bypass operation in British Columbia at five months. Another recent study, cited in a Heritage Foundation report, estimates 260,000 Canadians are currently waiting for major surgery.

There is no doubt that many Canadians like their system of health care, but it is unlikely that Americans would accept the dearth of hi-tech procedures and the waiting lists that are characteristic of Canadian health care.

The U.S. system, with all of its problems, works well for most Americans. The challenge of health care reform is to make our system work for all Americans.

J. Leonard Lichtenfeld, M.D.

Pikesville

The writer is a trustee of the American Society of Internal Medicine.

Underfunded

Herbert L. Dyer's letter defending the actuarial assumptions used in determining funding for the Maryland State Retirement and Pension Systems is terribly weak on explanations.

Assumptions consisting of an approximate 7 percent annual wage increase and a 7.5 percent return on investments are truly unrealistic. Taxpayers cannot be asked to pay 7 percent wage increases in future years -- and the plan has averaged 11.4 percent earnings on investments during the past five years.

Perhaps that is why the state's pension plans are underfunded by more than $6 billion -- thus mortgaging the taxpayers of Maryland for over $200 million per year for the next 30 years to pay off the overly generous benefits that have not been funded in past years.

David C. Becker

Timonium

Human Tragedy

I read with sadness about the young mother with post partum depression, which caused her to destroy her infants in a motel room. She had been treated by an HMO system and there was some question as to whether she received adequate psychiatric help.

I am concerned about financial coverage for psychiatric care, which may have played a role here.

Years ago, we psychiatrists knew a lot about theory and coulnot always treat every person, but patients seemed to have had adequate insurance coverage.

Things have changed, unfortunately. Insurance coverage has dwindled to the point that very little seems to be covered for psychiatric care. Many patients are forced to go to HMOs, and from my experience there is a paucity of care in HMOs for psychiatric problems.

There may be a social worker, counselor or perhaps a psychologist, but I have been disappointed in follow ups with patients who have become part of an HMO.

For a short period of time, I was even on the staff of an HMO but was disappointed with its control of the number of visits and the types of problems I was allowed to treat. I felt that patient care suffered.

Yet, in past years psychiatry has advanced tremendously. There is a much better understanding of mental illness. Excellent medicines and treatment approaches are now available and most patients improve.

It is true that psychiatric care will probably never be cost-efficient. Patients may need to be in treatment for longer periods of time and this cannot be justified financially in any way, except that it may help the patient.

I feel that there has to be a re-thinking of coverage for psychiatric care. Insurance will have to improve. And patients should be given the opportunity to have adequate psychiatric coverage so that incidents like this do not re-occur.

Alan H. Peck, M.D.

Baltimore

And Now a World

I'm sure Douglas Birch's article on the theory of the "Big Bang" (The Sun, May 31) has produced a spate of letters. Ever since the April 23 announcement that NASA's COBE satellite had generated a sufficient number of data points to supposedly validate the trembler "aftershock," I have been in shock.

That all we now see had originated from a point source of mass-energy exceedingly thinner than this sheet of paper is an idea of long standing. One can, however, easily raise some serious questions as to the origin of the source. What initiated its explosion? What is beyond the edge of space?

Contrary to the big bang, my belief tends toward the steady (eternal) state -- that is, that no more mass or energy exists now than at any other time (as we conceive time) within this contrivance we named the universe. I believe that is what Alexander Pope proposes in these few lines from his "Essay on Man, Epistle I":

Who sees with equal eye, as God of all,

A hero perish or a sparrow fall,

Atoms or systems into ruin hurl'd,

8, And now a bubble burst, and now a world.

William F. Seip

Baltimore

Career Employee

What constitutes a career employee?

After working from 1938 to 1968 with the Glenn L. Martin/Martin Marietta Company, I was told that I was not considered a career employee in consideration for a cost of living pension increase.

I and many employees with as much as 30 years service who were laid off due to lack of work are not considered eligible for a pension COLA in as much as we were not of pension age of 55 the time of layoff.

The company, however, considers a person 55 years of age with as little as 10 years experience as vested and eligible for COLA increase if they chose pension in lieu of layoff.

I sent a certified, registered letter to the chairman of the board in 1991 suggesting that all vested retired employees who were laid off (not those who quit the company) should share in any COLA funds, rather than the selected personnel at present. As of today, I have not received a written reply.

I have a pension of $55 per month after 30 years of service and am not considered eligible for any COLA.

Melvin W. Inners

Baltimore

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