Harford County TrashThe Sun's virulent attack on...

THE BALTIMORE SUN

Harford County Trash

The Sun's virulent attack on Harford County's private trash haulers surprised and angered me.

Harford County has had a long tradition of outstanding trash hauling service because it is an area which has remained in the private sector, driven by the profit motive and has not been watered down, cheapened or denigrated by being taken over by the governmental bureaucracy. The suggestion that the Harford County haulers are gouging the public is ludicrous.

First, there's far too much competition for that to be possible. Moreover, the county executive and county council of Harford County are responsible for the dramatic increase in the hauling fees.

We implemented for the first time in ten years a tipping fee of $35 per ton, which was bound to nearly double the charges that trash haulers were making.

It is hypocritical for any public official, whether elected or appointed in Harford County government, to put the blame on the private trash haulers for the dramatic increase in their service fees.

What is perhaps the most shocking to me is that The Sun has taken upon itself to condemn, though not by name, one hauler who has taken an especially progressive approach to the new tipping fee and recycling program.

He has implemented a per-bag trash service so that the family that reduces its trash dramatically will reap the rewards by a service cost that is actually lower than was possible before the tipping fee and recycling program.

The Sun seems determined to force the small private businessmen out of the trash hauling business in favor of the multinational trash haulers or perhaps a governmentally run trash service.

It's time to remember that America is a nation of free enterprise and small business. We should be supporting our local business people when they are doing their best to be progressive, rather than undermining them with unfounded criticism.

Jeffrey D. Wilson

Bel Air

F: The writer is president of the Harford County Council.

Baker is Choice Replace Bush

Regarding your editorial (Aug. 5) that asked who should replace George Bush as the Republican presidential nominee if he stepped down, the answer seems obvious to me: James Baker.

You mention the fact that Mr. Baker has never shown a willingness to endure the rigors of presidential campaigning, and might also have mentioned his dismal record in his previous runs for elected office.

Despite these facts, however, Mr. Baker's presidential aspirations are well known. The distance Mr. Baker maintains between himself and Dan Quayle, as well as his softening posture toward Israeli loan guarantees, can be interpreted as the first political maneuvers in the 1996 Republican primary campaign, which presumably would pit him against Mr. Quayle.

While Mr. Baker has never actively courted Republicans, or the rest of the country for that matter, on his own behalf, he most likely would have started soon after the November election in preparation for 1996. If Mr. Baker feels his chances this year are better than they will be in 1996, he could, and would, begin sooner.

This raises the second point mentioned in the editorial, the fact that Mr. Baker does not have a constituency. Mr. Baker's 1992 constituency would be anchored, however, by all those Republicans terrified by the prospect of watching the presidential coalition they have painstakingly built over the past 30 years dismantled, and in some cases co-opted, by the Clinton-Gore Democrats.

Although known for their loyalty, recent events make it clear that many Republicans have concluded that in order to save their ship, the Republican Party, they must get rid of their captain, George Bush.

In any case, a Baker constituency would be easier to build than a constituency for Mr. Bush, who at this point cannot even count on Republicans, and furthermore must be held accountable for the economy and other domestic problems.

A Baker candidacy has all the advantages of the Bush foreign policy successes, without any of the burdens of his domestic failures.

Add to Mr. Baker's ticket Jack Kemp, the housing and urban development secretary, as vice presidential nominee, and you at once placate right-wing Republicans that for some reason persist in their love of Mr. Kemp, and add a much-needed domestic agenda to a national ticket.

A Baker-Kemp ticket eclipses in stature and experience the suddenly small-potatoes Clinton-Gore candidacy.

A Baker-Kemp ticket would provide Republicans an irresistible alternative to the prospect of an uphill, lonely, and negative Bush-Quayle campaign.

The only one left to convince is George Bush.

Stephen M. Dolan

Joppa

Stick to the Merits on Mall Expansion

A recent editorial in this paper (Aug. 6) criticized Woodward & Lothrop's environmental track record and sought to cast doubts upon the company's sincerity in raising environmental concerns regarding the expansion of the Annapolis Mall.

While we certainly have no problem with the editors expressing their opinions, Woodies is disappointed that The Sun continues to be satisfied with casting aspersions on Woodies' motives, rather than investigating the merits of the case . . .

For starters, the editorial alleges that Woodies should be held responsible for environmental difficulties encountered in the siting of the Marley Station Mall . . . The Taubman Company began developing its Marley Station plans well before its affiliation with Woodies.

The editorial also criticizes Woodies for failing to improve the appearance of Parole Plaza . . . We are tenants, and there are definite limits -- both legal and practical -- on how much we can do to improve the plaza . . .

Woodies would prefer that all discussion of motives be put aside. Instead, all participants in this debate, including county officials and the media, should focus on the important issues raised by the Annapolis Mall expansion.

From Woodies' perspective, these issues are:

1. Traffic congestion: The existing road system in Parole is already heavily congested. Using standard industry traffic generation formulas, we estimate that in excess of 10,000 new vehicle trips will be generated daily by the mall expansion.

This new traffic will result in the worst possible levels of congestion -- levels not permissible under county regulations or federal and state highway standards. An unacceptable burden would be placed on surrounding neighborhoods and businesses. The traffic study submitted by the Annapolis Mall developers does not deal with this cumulative effect on the road system.

2. Air quality: It is obvious that such a drastic increase in traffic will result in a negative effect on air quality throughout the entire Parole area. Anne Arundel County already fails to meet some federal air pollution standards. Any increase in pollution levels poses a serious risk to public health, particularly for the elderly and those susceptible to respiratory problems.

Is it, therefore, so unreasonable to suggest that the Annapolis Mall expansion must not be approved until an accurate traffic analysis has been submitted, all needed roadway improvements identified and an agreement reached on how they would be financed? We think not.

3. Lack of public review: Actually, our primary concern about the Annapolis Mall expansion goes far beyond environmental issues and affects the very foundation of the fair, democratic processes so fundamental to the way our free enterprise system operates.

The fact is that a secret deal was struck between the Anne Arundel County government and the Annapolis Mall developers. This memorandum of understanding (MOU) circumvents the normal approval process and competely ignores the responsibility of conducting public hearings.

The MOU conveniently allowed the parties involved to make decisions in private, before the mall developers submitted the site plan, the formal development plan and the incentive plan proposal -- as required by law.

Is the desire to bring Nordstrom to Annapolis sufficient reason for the county to manipulate and ignore the law? If so, why have ordinances at all?

It is abundantly clear that everyone involved with the project -- from the owners of the mall to the county to The Sun -- continue to use Nordstrom as a shield to protect themselves from having to discuss the merits of the project. The public has every reason to be concerned when its elected officials are ducking an issue.

Woodies and the Parole Plaza merchants simply seek a public forum for raising and dealing fairly with our concerns and those of others who may be adversely affected by the proposed expansion of the Annapolis Mall. No one seems willing to provide this public forum.

Unless the county has something to hide, what possible harm can come from permitting all those with an interest in the project to be heard? That's the real issue that must be addressed.

Robert J. Mulligan

Alexandria, Va.

F: The writer is vice chairman of Woodward & Lothrop Inc.

Treatment of Graves Disease

We are writing to applaud your coverage of Olympic Gold Medal winner Gail Devers' recovery from Graves' disease and to correct several misconceptions in Ken Rosenthal's August 2 story.

Ms. Devers suffered from a common condition in which the thyroid gland enlarges and releases excessive amounts of thyroid hormone into the blood.

Palpitations, excessive sweating, nervousness, muscle weakness and weight loss are typical complaints in patients with this problem.

Some patients develop protrusion of their eyes, but they are in the minority.

Like many patients, Ms. Devers may have suffered needlessly because her illness was not diagnosed in a timely manner.

However, although Graves' disease is a serious disorder, which may even be life-threatening in rare cases, it is not a pre-malignant condition and is not associated in any direct way with thyroid cancer.

Therefore, it is impossible for her condition to have been "two weeks away from being cancerous."

Most patients in the United States with Graves' disease, including President and Mrs. Bush, ultimately receive radioactive iodine treatment. A pill containing iodine, which has been made radioactive, is taken orally; the radioactive iodine is then concentrated within the thyroid gland.

In the ensuing weeks to months, the radiation destroys much of the gland's ability to function. The patients are usually cured by this definitive treatment, but often must take thyroid hormone for life, because their own thyroid gland can no longer produce the ** required amount for good health.

Recognition of this under-active thyroid condition is quite easy with appropriate blood tests, and taking thyroid hormone supplements is quite simple; one small pill taken daily can almost precisely reproduce normal thyroid function.

A number of misconceptions about Ms. Dever's treatment appeared in the article.

First, radioactive iodine therapy does not cause excessive menstrual bleeding, hair loss or impairment of memory.

All of these symptoms can occur if an under-active thyroid is not recognized and treated, but this should never happen with proper medical attention.

Nor are they a complication of radioiodine treatment. We know of no similar experience in all of the medical literature. One can only speculate about the true cause of her problem, from which she has fortunately recovered.

Often when prominent persons develop an illness, their experiences provide insight and inspiration to other people with the same medical problem.

This has certainly been true of President and Mrs. Bush's battles with Graves' disease, and should also be true of Ms. Devers.

It would be unfortunate, however, if unrelated problems led to misconceptions about thyroid disease, or to unfounded fears about safe and effective treatments that are available to cure them.

If readers wish additional information on Graves' disease, they should contact:

The Thyroid Foundation of America, Maryland Chapter, at the Division of Endocrinology of Sinai Hospital.

David S. Cooper, M.D.

Paul W. Ladenson, M.D.

Baltimore

The writers are, respectively, director, Division of Endocrinology, Sinai Hospital, and director, Division of Endocrinology, Johns Hopkins Hospital.

Health Care Crisis

If you are lucky enough to have health insurance and think the health care crisis doesn't affect you, then think again. Allow me to explain.

There are basically two types of health insurance:

* Indemnity insurance (Blue Cross/Blue Shield, for example) pays a physician a fee for services rendered.

* A managed care plan (a health maintenance organization or a preferred provider organization) either pays a physician a reduced fee for service or a "capitation." With capitation a physician is paid a monthly salary based on the number of patients enrolled in the HMO plan. In return the doctor provides all the needed services.

The costs of these plans are underwritten by premiums paid by (( either the employer or the patient. The problem is that these premium dollars are not finding their way back to the health care provider. Many fee-for-service plans are holding back money even after claims are submitted.

There are even anecdotal stories of claims representatives throwing completed insurance forms in the trash can, because they are too busy to process them. When the insurance company is finally challenged by the physician or the patient who has received a bill, the standard answer is "we never received the claim."

Another ploy by the insurance companies and managed-care plans is to deny payment to the physician because there was not a proper referral from the primary care doctor or because the claim form was not filled out properly.

It may take up to 60 days for the plan to inform the physician that the claim has been denied, thus prolonging the time between when the physician corrects the problem and when he or she gets paid.

The capitation system is even worse. Even though the physician gets paid on a monthly basis, the capitation is usually far less than what the physician would make on a fee-for-service basis.

Any consultation for further testing comes out of the capitation -- fee, so the incentive is to provide as little care as possible to the patient, lest the doctor lose even more money.

Capitated HMOs usually overwhelm their doctors with high volumes of patients. Large volumes do not equate to more money for the physician, but to physician burnout and more mistakes in clinical judgment.

And finally, there's that all-payer system called Medicare. The government has virtually stopped paying all claims to Medicare. The doctors have been told that they will be paid but no one knows when.

Try telling the cashier at the food store that you'll pay her but you're not sure when. There are untold numbers of unpaid claims that are nine months or more outstanding.

It takes money to run a medical practice. Rent and utilities must be paid. Increased staff is required to process and reprocess claims as well as keep track of referrals and provide patient care to the large volumes of patients in capitated programs. Malpractice insurance must be paid.

Physician reimbursement is down while health insurance premiums are skyrocketting. So where is the money going? Much of it is going to large corporate salaries for health insurance executives as well as sky boxes, advertising signs in left field and umbrella give-aways at Oriole Park.

It is high time that the health insurers be held accountable. Otherwise, the people lucky enough to have health insurance may soon find that their doctors are out of business.

Robert L. Brenner, M.D.

Baltimore

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