Looking down his office driveway at the wooden ranch-style sign, the rusty horse trailer, chicken coop and Jerseys grazing in the back pasture, it might be difficult to place Dr. Melvin Stern on the cutting edge of a hot national issue.
But walk up along the split-rail fence and into his crowded waiting room, and his agenda might be easier to understand.
"For every dollar spent immunizing kids, we save $10 in potential cost for caring for sick kids," says Dr. Stern, sitting in his cramped inner office overlooking the pasture.
On Nov. 14, Dr. Stern, 48, will be honored as Pediatrician of the Year by the Maryland Chapter of the American Academy of Pediatrics. The title, in large part, recognizes his advocacy of state legislation requiring Maryland employers who offer health insurance to buy policies that cover child preventive care, such as immunizations, screenings and physicals.
"Kids just don't have a voice. They don't vote. They really don't have the lobbyists," said Dr. Stern.
But after three years of testifying in Annapolis, calling pediatricians across the state and in turn rallying parents to contact their legislators, Dr. Stern and a nascent coalition of children's advocates achieved results in March.
"If we never ever spend another dollar on anyone under 21, the net impact on the health-care dollar would be no more than 12 cents," said Dr. Stern, echoing an oft-repeated argument. The tradition of covering children's visits to the doctor only when they're sick, he added, costs more money than it saves.
"He worked extensively on getting the Child Wellness Services law passed," said Mary Francis, administrator for the state pediatric chapter. Dr. Stern's award also recognizes his dedication to his 11-year-old Highland pediatric practice and other work in the field, she said.
And not covering preventive medicine is but one facet of a deeply flawed health-care system, Dr. Stern contends.
Fixing it will take much more than health-insurance devices such as health-maintenance organizations (HMOs) or preferred-provider organizations, he said.
"The system is broken. All of this is just tinkering around the edges."
What the nation needs, Dr. Stern believes, is a completely new system that spreads expenses through the entire population and shrinks the overhead that insurance companies now charge.
Such an overhaul will require a change in the way health care is approached by consumers, providers, insurance companies, drug companies and the government.
"At least in Maryland we're beginning to pull together a coalition" to work on pediatric concerns, he said.
The group, called Ready At Five, including businesses such as IBM and C&P; Telephone, senior citizens groups and governmental agencies, helped push through the legislation this year.
In 1990 the legislation died in committee. The next session, lawmakers formed a board to review the proposed insurance mandates, and with the board's recommendation, the coalition was able to get the mandates passed this year.