Share the RiskThe crisis in health care...

THE BALTIMORE SUN

Share the Risk

The crisis in health care continues to grow. To exacerbate the problem, some existing Maryland health maintenance organizations and some new ones coming into our state are offering lower rates to potential business subscribers whose census reflects lower than average risks. The end result will be that these lower risk groups will be skimmed off by the lower price offering, leaving the higher risk groups with the Maryland Blue Cross and Blue Shield.

A small employer who has one employee with a major illness is denied the ability to change carriers for a lower rate since no new carrier will accept his group. Increasing rates to these small groups are becoming prohibitive, and the consequence will be more uninsured.

Although I have little sympathy for the Blues in the light of recent revelations, the Blues are being adversely affected by this process.

Soon, those covered by the Blues will not be able to afford the premiums in these remaining groups, which will contain a disproportionate number of the chronically ill.

A fairer method would be, if the market is to remain open, to force all HMO's to share the poor risk groups.

Another alternative would be to let employers assign the chronically ill to a special group that would be underwritten by all the insurance premiums in the state, similar to the old Assigned Risk Automobile Insurance program.

Gerald Jeffein

Baltimore

A Board for Paramedics

It is fairly obvious that the area of Emergency Medical Services (EMS) in the state of Maryland is going through many changes. Philosophical paradigms throughout the political structure of Maryland EMS have crippled the progress of EMS as a profession, in comparison to major EMS systems in other parts of the country.

One vital example was discussed in an Oct. 11 article, "What the rescue crew can't do to save you," where endotracheal intubation, considered to be a "gold standard" technique for paramedics, is prohibited from being used in a few jurisdictions, even though some of the personnel are nationally registered to perform this technique.

Dr. Kimball Maull, the newly appointed director of the Maryland Institute of Emergency Medical Services Systems, when asked about this problem in the article replied: "My reaction is embarrassment."

Currently Nationally Registered Emergency Medical Technician-Paramedics (NREMT-Ps) are certified to function in Maryland as a delegation of duties by a licensed physician.

When EMS was in its infancy this structure of physician-delegated practice was formed as a matter of necessity to guide the initial direction of pre-hospital EMS. With the birth of baccalaureate and graduate studies in emergency health, as well as a field that is greater than 25 years old, I feel review of the legislation regarding paramedic certification is due.

A paramedic is recognized by the American Medical Association as a medical professional. In Maryland, a paramedic functioning as a physician designee is not a recognized medical professional in the same league as nurses, respiratory therapists and pharmacists.

The Department of Health and Mental Hygiene utilizes boards of peers to license members of certain professions.

For example, there is the Board of Nursing and Board of Pharmacy. There even exists a Board of Barbers, a Board of Cosmetology and Board of Funeral Directors. Currently there is no similar board for paramedics.

Perhaps the Governor's Task Force on Emergency Medical Services can examine the issue of creating a "board of emergency medical technician-paramedics," whose function would be to license paramedics in Maryland.

This would elevate the professional status of the paramedics to the same level as other AMA-recognized health professions. I believe that the benefit derived from this would translate into improved care, new techniques, and increase the impact that we pTC have on saving lives.

Gregg S. MacDonald

Marriottsville

Good Coverage

I would like to commend The Sun for your excellent coverage of the abortion referendum in the Perspective section (Oct. 18).

The parallel question and answer columns were quite informative, but what I really appreciated was your printing the entire text of the law itself.

I get so tired of lobbyists telling me what something says. I like to read it for myself to see what it really says. Then I can evaluate what the lobbyists are saying about it. (After reading the law, I thought the Vote kNOw answers to your questions were generally more honest.)

To the best of my recollection, this is the most in-depth presentation of the abortion issue The Sun has published.

Beyond the stream of immediate news, such as marches, court decisions, laws, quotes from activists and editorials, I have been quite disappointed by the news media's poor coverage of the underlying issues over the past 20 years.

I have never seen the text of Roe vs. Wade published, yet it is clearly one of the most controversial documents of the Twentieth Century.

The pro-choice folks say 10,000 women a year died from illegal abortions before 1972, but Vote kNOw said 39 died in 1971. Where do those statistics come from? How many have died since? What does medical research have to say about viability, and when life begins?

The abortion issue persists because it touches deep legal, economic, medical, philosophical, theological, and cultural issues. How about turning some (unbiased) investigative journalists loose to scrutinize the substance behind the statistics, slogans and rhetoric? Deeper understanding of the issues usually leads to better choices.

Art Moorshead

Lutherville

Key Question

The question isn't about whether you are better off now than you were four years ago but whether the country is better off today than it was four years ago.

Julia Yohn Pickett

Baltimore

Abandoned Infant

I was dismayed to read your story about "Baby Moses" ("Newborn Found in Grocery Bag Doing Fine at Hospital," Oct. 22).

The chances are good that his mother was very young, used drugs and alcohol throughout her pregnancy, was intellectually limited and perhaps mentally ill. It is unimaginable that there was any prenatal care, and there was obviously no obstetric care.

Thus, little "Baby Moses" or whatever he ends up being called is at very high risk for birth defects, limited intellectual potential and possible mental retardation or psychosis.

I am sure that all the pro-life middle-class women who line up in front of abortion clinics intimidating and traumatizing young non-mothers-to-be will be lining up in front of Social Services at the break of day tripping over each to adopt the baby.

Robert Fiscella, M.D.

Baltimore

Fighting Whom?

Perhaps the most interesting claim made by Sen. Barbara Mikulski in her debate with Alan Keyes is that she is in the Senate "fighting" for our interests. This bit of legislatorese evokes the comical image of our pugnacious senator hurling herself upon astonished Republicans in business suits.

And it piques our curiosity. Are Senate fights divided into weight classes? What weapons do Democrats favor? Sausages at 20 paces?

Alas, we know only too well that "fighting" is a metaphor for the legislative process; and as Mr. Keyes points out, we are being annihilated by "friendly fire" from pork barrel generals, who spend our money faster than they can confiscate it.

And who can blame General Mikulski for pushing forward when her campaign has been so effective: The private sector is crippled; the people of Maryland are more dependant on the federal government than ever before.

No wonder Senator Mikulski is so confident: She has the full corrupting power of the government behind her.

"Very destructive" are the senator's words for the effect of the federal government when it interferes with people's lives. Bullseye.

But wait: She is describing what happens when the government interferes with abortion. Other kinds of government interference are just fine, if her voting record is any indication.

Yes sir, she is a fighter all right. The only problem is that she is fighting us.

Barton M. Cockey

Baltimore

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