SickenedOf all the outrages I could get...

THE BALTIMORE SUN

Sickened

Of all the outrages I could get angry about in these violent, corrupt and frantic times, I cannot think of one that makes me so furious as this continuing parade of wealthy people who do not pay the Social Security of their home help.

It is even worse when they winsomely assert that they didn't know the law. Not only do these expensively educated would-be leaders of the country believe they are exempt from its laws, they apparently take the rest of us for idiots who will swallow any ridiculous excuse they contemptuously toss out.

Perhaps Bobby Ray Inman figured he didn't have to pay because he was not expecting to be tapped for a high federal post. Perhaps he is a secret illiterate who didn't read about all the other cases. Perhaps, being no longer poor himself, he finds such small amounts of money too insignificant to concern him.

These people make me physically sick. How many more of them are out there?

Michael Kernan

Baltimore

Air Guard

Martin Zemel's Nov. 7 letter questions whether every state needs an Air National Guard (ANG) and, if so, why not merge ANG with the Army National Guard.

I agree with Mr. Zemel's point that it's unlikely a governor will have to call for an air strike "to quash civil unrest." However, many governors have called on their ANG units to deliver humanitarian relief following a natural disaster.

During the recent tragic brush fires in California, several ANG units played a prominent role in fighting these brush fires. Many ANG units were involved in air-lifting humanitarian relief to this summer's flood victims.

When the United Airlines jet crashed in Sioux City, Iowa, some years ago, it was ANG units that took the lead in providing aid to the crash victims. I think the record will show that the ANG has a proud tradition of providing aid and assistance when disaster strikes. The members of each state unit take great pride in lending a hand when their neighbors truly need a hand.

Just as the '80s will be remembered as the decade of hostile takeovers and leveraged buy-outs, the '90s will be remembered as the decade of streamlining and down-sizing. Down-sizing and streamlining do not occur without costs.

Having states share an ANG unit may work in theory. However, in practice I can see governors and other politicians squabbling over when a unit would be activated and which state should shoulder the financial burden. I believe history will show that not every down-size or streamline action resulted in the promised savings or efficiencies.

While every member of the ANG recognizes that our role changes as world events unfold, we would prefer that the ANG tradition not be sacrificed in a rush to "down-size."

Simply combining two organizations, both of which have proud traditions of service to the citizens of Maryland, will not necessarily result in a cost saving and increased productivity.

As my father was fond of saying, "Son, before we can fix the truck we've got to know what the problem is." The members of Maryland ANG have served and continue to be ready to serve the citizens of Maryland.

Robert A. Monniere

Ellicott City

N The writer is a captain in the Maryland Air National Guard.

Pressman Said

Ten years ago, then City Comptroller Hyman A. Pressman was the guest speaker at the Exchange Club of Highlandtown.

Some of his remarks bear repeating. Mr. Pressman said:

"I have a great love and respect for democracy and representative government, and for our laws as an instrument of justice.

"I believe that if those laws are observed and enforced, you, as a citizen and taxpayer, can be protected from arbitrary and unjust acts of public servants."

Joseph Bormel

Baltimore

Shared Blame

The recent tragic deaths on the Chesapeake Bay can be attributed to the late rockfish season.

Once the rockfish have spawned in the spring, there is no biological reason to delay the season until late fall. The weather is often bad, and hypothermia is always possible if a fisherman falls overboard.

In my opinion, Maryland and Virginia officials are directly responsible for putting the fishing public in danger.

George Boyer

Edgemere

Barclay Principal

The article concerning the achievements of Principal Gertrude Williams and students at the Barclay School in the Dec. 12 Perspective section was a breath of fresh air to me.

First, it was positive. Second, Principal Williams has given a rebirth to the attitude that athletic coaches have adhered to as long as I can remember: Practice makes perfect. And last, Mrs. Williams has proved that one person can make a difference.

God bless her!

William G. Huppert

Perry Hall

Physicians and Ethics

The Sun should be ashamed. What a ridiculous and absolutely false portrait Daniel Greenberg paints of medical doctors in his Opinion * Commentary article, "Doctors Who Care for Doctors," Dec. 21.

Mr. Greenberg deserves a demerit if not a demotion, especially if he is to be cited as an expert in "the politics of science and health."

I have been in the practice of medicine in this city for over 20 years. I have never been the recipient of "an all-expense-paid medical seminar" anywhere. No Caribbean. No Alpine ski resort. No trips anywhere.

In conducting a personal poll among my colleagues, I found no physician who has enjoyed such a vacation. I am sure Mr. Greenberg will argue that this practice has been in existence, but I would ask how prevalent was or is it?

Most awful is that Mr. Greenberg and The Sun would have the readership believe that this "perk" is a commonly appreciated and readily available "freebie from the drug companies." I would counter this and question the accuracy of the impression given.

In this era of doctor-bashing, such an inflammatory remark will cause many a finger to be waved at the medical profession. But is this accusation deserved?

Show me some statistics that prove how widespread this custom has been, and please make them current enough to at least apply to our generation. We shall not be held accountable for the sins of our fathers.

Stan Brull, M.D.

Baltimore

____________

Daniel S. Greenberg wrongly implies that physicians act improperly if they bill an insurance company for a procedure yet forgive some or all of the co-payment.

Most medical insurance policies are written not to require the patient to pay a portion of the total sum billed, but rather to reimburse the patient a percentage of the "reasonable and customary" cost of the care given.

It has always been unethical to falsely inflate a fee in order to

obtain greater reimbursement that "makes" up for what is forgiven a patient. In any event, insurance companies do not pay above their determination of "usual, reasonable and customary."

Is it wrong for a university to accept lower tuition from the children of academics, or for an auto mechanic to charge less to another mechanic, or for a lawyer to represent a colleague for less than his standard fee?

Professional courtesy is routinely practiced in many professions, trades and businesses as it is in medicine: a courtesy, not an expected right.

If the physician bills his true "usual" fee, it is his business alone whether he elects to accept a lower total fee in selected cases by reducing the co-payment due from the patient. We are, after all, talking about his income, not the cost to society or an insurer.

While from a systems point of view co-payments may serve to discourage unnecessary treatment and contain costs, this is irrelevant to the ethics of forgiving co-payments on an individual basis.

What is missed in the pseudo-egalitarian argument posed by Mr. Greenberg is that physicians reduce co-payments vastly more frequently to help needy patients than they do for fellow physicians.

Many people could not afford needed medical care if their co-payment were not partially forgiven by physicians, hospital and clinics that use sliding scales. It is the patient, not the insurer, that is given a break.

!Jesse M. Hellman, M.D.

Towson

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