Missing PointThe press has been so busy...

THE BALTIMORE SUN

Missing Point

The press has been so busy defending Governor Schaefer against Money magazine's ridiculous charge of being "the most pampered prince of perks" that it is missing the main point -- government officials hiding the facts about how well they live at the expense of the taxpayers.

Money magazine had this to say in the Editor's Notes column: "When Money's reporters asked them (the governors' offices) as part of our comprehensive survey. . . we ran into more orchestrated resistance than we have ever encountered in our 21-year history."

"The National Governors' Association, a Washington D.C.-based

lobbying and research group whose $10.8 million annual budget comes largely from taxpayers, appears to have warned all 50 governors about the potential consequences of cooperating."

All these matters are matters of public record, yet some officials flatly refused to respond to questions of how well governors were living, some declined to answer a number of questions, two seemed purposely vague. In fact only seven states cooperated fully and promptly . . . and one of these was not Maryland.

What seems completely lost in politics today is the concept that these people are supposed to be public servants.

C. Morris

Edgewater

One Termers

Theo Lippman Jr.'s Sept. 20 column regarding the two ex-presidents spending the night in the White House missed a key point.

The three living ex-presidents (George Bush, Jimmy Carter and Gerald Ford) who came to the White House to join President Clinton in supporting NAFTA were all one-term presidents who were defeated for re-election.

On the other hand, the two living ex-presidents (Richard Nixon and Ronald Reagan) who were unavailable to come to the White House won landslide re-elections.

I'm betting that Bill Clinton will join George Bush, Jimmy Carter and Gerald Ford and be a one-term president, defeated for re-election.

Leon Reinstein

Baltimore

Bitter Pill

Through the North American Free Trade Agreement, President Clinton is trying to drive down salaries, which will result in a lower standard of living in the United States. He is trying to do this maybe for all of the best intended reasons, such as making us more competitive in the world markets. However, the effect will be a bitter pill to swallow.

What concerns me is Labor Secretary Robert Reich's statements concerning retraining and assistance for those who are displaced and abused by the agreement. Who do you think will finance these programs?

It's obvious that the very people who will be hurt the most will pay these bills, the middle class. We in the middle class seem to pay all of the freight.

Mr. Clinton's health package will be similarly financed on the backs of the middle class, who will see a corresponding reduction in the quality of their health care.

We just spent 40-plus years and far too much of our wealth to prove that socialism will not work. Why is Mr. Clinton trying to prove that he can make it work here?

Robert L. DiStefano

Parkville

Persons with Disabilities

The article, "Armless bowler rolls 300 at life," by Tom Keyser, Sept. 19, set back disability rights at least 20 years. Its focus -- a life of dependence and struggle -- does not accurately reflect the lives of countless persons with disabilities, including those without arms or legs, who have achieved independence and full participation in society.

The premise of recent civil rights legislation -- the Americans With Disabilities Act (1990) -- is that persons with disabilities can maximize their potential and live independent and productive lives.

Although some disabilities may preclude full-time or even part-time employment, most persons with disabilities can be independent and self-sufficient. The subject of the article, David Hicks, who lost both arms in a motorcycle accident in 1988, may have a disabling condition that precludes his use of prostheses or full employment. Since I do not know Mr. Hicks, I cannot presume to speak about his circumstances.

However, the article and some statements in the text foster stereotypes about persons with disabilities. These cultural myths must be dispelled.

1. I question the need for The Sun to engage in tabloid journalism. As noted in a recent Sun book review of Joseph Shapiro's "No Pity: People with Disabilities Forging a New Civil Rights Movement," there are two pervasive stereotypes about disability -- the disabled as pitiful, and as inspirational.

News stories which elicit from readers either emotion are examples of tabloid journalism (euphemistically referred to as "human interest" stories).

2. Disabled persons are not children and should not be infantilized. It is unfortunate that Mr. Hicks refers to himself as a "30-year-old man caught in the time warp of a 1-year-old kid," reinforcing a stereotype of the disabled as helpless infants.

3. Disabled persons should not be objects of inspiration simply because they participate in life. Although admiration on the part of others may be well-meaning, it is, nevertheless, a form of paternalism which has fostered "supercrip" images of disabled persons . . .

4. Persons who assist disabled individuals are neither saints nor Mother Teresas. It is true that some persons with disabilities may need assistance in activities of daily living . . . Prosthesis, mobility aids and computer technology have greatly augmented the independence of persons with disabilities. With technological advancement and minimal ADL assistance, it is not unusual for a person without arms or legs to participate fully and independently in society, including operating an automobile. The image of the ADL assistant as saint demeans persons with disabilities, as objects of care and charity.

5. Disabled persons should not be perceived or treated as burdens. Mrs. Hicks' comment that she sometimes "threatens" to leave her husband alone may be the offhand remark of any spouse who has cabin fever or who needs time out.

In the context of Mr. Hicks' avowed dependency and helplessness, however, such an otherwise innocent quip takes on another meaning. Some readers may interpret her remark as affirmation of the burden of her husband's disability, a disparaging notion surely not intended.

6. Disability is not tragedy. I shall not trivialize anyone's experience by trying to romanticize disability. References to disability as "challenging" or "enabling" are, for me, nauseating. Here I would commend Mr. Hicks' for his position that "This is the way it is, no sense crying or anything else."

In contrast, the article as a whole reinforces the idea that Mr. Hicks has lost not only his arms but also his independence. That need not be the case for Mr. Hicks or most persons with disabilities.

What is most redeeming about the article is the reporter's observation, despite Mr. Hicks' declaration ("You can't do anything without arms") that Mr. Hicks can do a lot:

He mows the lawn, turns pages of a book, kicks firewood up to the house and changes diapers -- all with his feet. Needing some help does not make one helpless.

Since I have arms and legs (I have been disabled for 47 years and use a wheelchair), my experiences are different. My own research, however, has included interviews with those who have lost use of their arms -- all of whom decry being sources of others' awe.

I suspect the Hickses also want to be perceived as ordinary persons, who have ups and downs and are rightfully offended by pity and paternalism . . . The article, in contrast, revisited tired cultural myths which reduce disabled persons to their body parts.

Marilynn J. Phillips

Hampstead

The writer is an associate professor of English and a researcher in disability studies at Morgan State University.

Managed Care Will Block Access to Specialists

My "primary care" doctor is the head internist of a 500-plus physician health maintenance organization. His training was excellent. He capped it off by being picked to be chief resident at University of Virginia Hospital nearly 20 years ago.

And he's kept up. His reputation among patients and his peers is excellent. And he usually does what I ask him to do -- with respect to referrals, etc.

But I don't have to see him very often -- perhaps for a routine physical every one to three years. In fact, since I had a possible "coronary" event five years ago, my cardiologist has given me most of my annual physicals.

Incidentally, my "coronary event" turned out to be, by therapeutic trial, an esophagus spasm. I've given up Cardiozem, which I was taking under my cardiologist's care as a precaution. Nevertheless, I see him more often than I see my internist.

The same is true for my neurologist. I've seen him more often than my "primary care" physician in the past two years (12 times vs. none) for my post-polio syndrome (PPS).

Now my internist was unsuccessful in trying to manage my recurrent, chronic sinus infection, but an ear-nose-and-throat specialist prescribed a successful program in a 10-minute visit.

My point is that the kind of medical care we usually need for common problems (cardiovascular and sinus) and rare ones (PPS) is best handled by a specialist. There is one for anything and everything.

Human biology and medicine are complicated. We have evolved and used specialists because we need them.

Do we really need them, or can the "primary care" physician handle the problems? In my case, the common problems were either too subtle or too resistant to treatment, and a specialist was needed.

The rare problem was not even in the experience of the HMO neurologists (three) or orthopedists (five); they'd never seen a case. I had to network myself into appropriate care outside the HMO for diagnosis and treatment. And, as I am a highly connected super specialist, I found and got to see super specialists at the Hopkins and the National Institutes of Health.

Currently I am in remission and even improved -- thanks to two clinical trials at NIH -- something not expected in PPS. This would never have happened if I'd stayed with the HMO neurologist. I would be using more and more appliances rather than fewer, and doing physical therapy rather than racing my sailboat again for the first time in three years.

The HMO doctors would have learned from me, watching me deteriorate. Instead, I sought and found better care. And generally big groups like HMOs are better if they are aggressive, which they often are not, because that costs money for time and care.

My weakness had become so bad that I had to employ a driver for almost a year. Now, I have been driving myself for 15 months. I might not even be practicing if I had not referred myself out of the primary care-oriented HMO.

But again, my point is that we need specialists. They take better care of virtually all of our illnesses, all of which are special to those of us who have them.

Of course, "primary care" physicians serve as "gatekeepers" to the specialists. But that can be, and often is, detrimental to the patient who may desperately need a specialist, or even a super specialist.

We didn't evolve specialists because we need them less but because we need them more. And we still do -- even more so.

To begin training more primary care physicians and fewer

specialists is going backward. We don't have fewer, less complicated diseases. We often need more specialized and complicated diagnostic and treatment procedures. And the primary care person is sometimes not aware that they exist.

Thus, inadequate care, as in my case, is all too common. Is that what we want? If so, we can probably get it from managed care through HMOs.

Recently at a state medical society meeting, a fellow faculty member said he knew what care was, but when managed it becomes something other than care.

Arnold Relman, editor of the New England Journal of Medicine, indicated in a lecture two years ago that managed care, as part of the "medical-industrial complex," is not in the best interests of patients or physicians, but of business.

And managed care given through primary care "gatekeepers" will limit access we need to specialists. This seems to be rationing for everyone. I don't like it. America deserves better.

R. Ben Dawson, M.D.

Columbia

Doctors Are Not Overpaid

It appears to be the view of the Clinton administration and the popular view that doctors are overpaid and under-worked.

It has been my experience as a financial adviser to doctors and as an outside observer that the above is far from the truth.

Considering the extraordinary amount of time, effort and dedication required to become a doctor, it is difficult to understand the logic of legislators who would like to limit the compensation of doctors. To become a doctor requires four years of high grades in college followed by four years of medical school. Three to 10 years of residency (long hours at little pay) are followed by entering an uncertain job market.

Once in practice, a doctor must spend long hours studying for licensing exams and continuing his or her education.

This is in addition to the time they spend seeing patients and running a practice, often spending nights and weekends working.

Certainly the time, effort and expense required to become a doctor and stay in practice merit relatively high compensation.

Consider also that an individual's pay should be a function of the magnitude of the decisions and risks he or she must make and take. Clearly the health decisions -- sometimes life and death -- that doctors must make merit commensurate pay.

The fact is that the average compensation for physicians and surgeons in this country is around $120,000 -- certainly not excessive in light of what we call upon them to do.

I am aware of gas station owners who earn substantially more than some doctors. Should we limit their pay?

Should we limit the pay of lawyers? Of professional athletes? Perhaps we should limit baseball players to $1,000 for a base hit, $5,000 for a home run.

The Medicare changes limit compensation for certain procedures regardless of the individual talent of the doctor performing the procedure. Wherein lies the difference?

Those who would argue that health care is unaffordable and that it is denied to many people have not been to a public hospital emergency room lately.

All who enter are provided care, including every drug dealer who gets shot in a gun battle!

I am not suggesting that we should feel sorry for doctors. But I am suggesting that if we are not careful, we will eliminate the incentive for some of our best and brightest to become doctors.

The quality of our health care system will not survive if we reward our doctors' dedication with Medicare restrictions and excessive debt.

Michael J. Trimble

Towson

Another View on Kennedy Center Strike

In his article, "Sour Notes on the Picket Line . . ." (Perspective, Sept. 19), Stephen Wigler offers his conclusions on the current difficulties in the orchestra industry in general and in the Kennedy Center Opera House Orchestra's strike against the Kennedy Center in particular.

Mr. Wigler cites a large number of "facts" to support his conclusions. His facts are mostly wrong.

The article begins with a number of miscues. Untold to Sun readers in this article: A position in the Opera House Orchestra, according to the Kennedy Center proposal, would lose economic viability at the end of next year, since the center's contract offer is for a 60 percent pay cut beginning with the 1994-95 season.

We are not, as Mr. Wigler asserts, "free lance" musicians. Vacancies in the orchestra are filled by nationally advertised auditions, just as is done with the Baltimore or National Symphony Orchestras.

Mr. Wigler is of the opinion that the Kennedy Center wants to replace the Opera House Orchestra musicians with members of the National Symphony. The Kennedy Center did state that position at one point in the negotiations, but the economics of the two orchestras defy this solution.

A member of the Opera House Orchestra is obligated to perform a minimum of 700 hours of work annually for ballet and opera in the orchestra's 28-week season. Some of the musicians perform as many as 200-300 additional hours annually for musicals.

Members of the National Symphony are called to approximately 800 hours per year over 46 weeks for their full-time job. The indisputable fact remains: we work nearly as many hours as the National Symphony in slightly more than half the time, for barely half of the wages. . . .

The article goes on to say that NSO musicians have sacrificed two weeks of pay in their support of the Opera House Orchestra picket line. This is completely wrong.

The National Symphony canceled two "Pops" concerts on Sept. 10 and 11, when the musicians of the orchestra and featured soloist Marvin Hamlisch notified the symphony management that they would honor the Opera House Orchestra picket line for those services.

The symphony held all of its scheduled rehearsals for the week, and its musicians were paid for their services.

Last week, the symphony management canceled the opening concerts of the subscription season, but the musicians continued to rehearse, albeit at Constitution Hall, and collected their regular pay.

Mr. Wigler attempts to draw some parallels between the situation in Washington and another dispute in St. Paul, involving the St. Paul Chamber Orchestra, the theater in which they perform and the Minnesota Opera.

The situations are in no way similar, with the management in St. Paul attempting to force the musicians of the Chamber Orchestra to become strike breakers in a dispute between the Minnesota Opera and the resident orchestra it has used for more than 30 years.

In an industry like ours, which understands very well how to do concessionary bargaining in difficult times, the St. Paul situation stands out as one of the poorest uses of the blunt-force tool of threatened bankruptcy. It is a tool to force musicians into unnecessary give-backs while offering no solutions to the chamber orchestra's real economic and institutional problems.

The cruelest point Mr. Wigler tries to make involves our colleagues in the National Symphony. They aren't here to answer his point, as they are winging their way into Russia as I write this.

Mr. Wigler contends that, several years ago, an unnamed former executive director of the National Symphony made a bad and destructive deal with the symphony's musicians because he was trying to preserve a shot at a bigger job. That former executive is Henry Fogel, now executive director of the Chicago Symphony and widely regarded as one of the wisest and far-thinking mangers in the industry.

In the 1985 negotiation, he agreed that the best way to use the available funds would be to offer the orchestra an increase in seniority benefits. And the orchestra musicians agreed.

Far from making a poor business decision, Mr. Fogel's solution to that negotiation preserved the NSO's salary parity with the rest of the industry -- the crucial factor in developing and maintaining a world-class orchestra.

All of these flaws of fact weaken the arguments in "Sour Notes . . ." We can, however, agree wholeheartedly with one of Steve Wigler's assertions: Absentee trustees, poor marketing and impoverished programming do add up to bad management. Throwing musicians from the picket line into the unemployment line does not repair the institutional problems that plague the Kennedy Center and many other arts organizations.

Melanie M. Mattson

Washington, D.C.

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