Let doctors manage health care

With managed care a pivotal aspect of the current debate on health care reform, it is time for the public to hear directly from health care professionals what it is like to work in a health care system that is dictated by managed care.

What managed care means to the physician is that we usually have to obtain pre-authorization for expensive medical procedures and contend with gatekeepers or case managers who control access to medical care.

Often we must obtain a second opinion to perform elective surgery,and we must prove that our patients meet criteria for medical necessity based on standards which insurance companies have made.

What it means to our patients is that they may very likely have direct contact with a gatekeeper or case manager.

If the recommendation for an expensive procedure has been made, they can expect their physician has probably discussed their case with a gatekeeper; and should they have to be admitted to a hospital, the chances are very high that their discharge date has been pre-determined by their diagnosis, rather than by their speed of recovery.

We don't argue with the goal of trying to control health care costs. What we question is whether this is the best method.

Although intended to control the high costs of health care, there have been significant problems with managed care interventions. Managed care has not proven to save any money nor improve the quality of medical care.

Furthermore, managed care itself costs significant amounts of money as reviewers' goal is to minimize your use of resources. Although physicians' fees are regulated, there are no regulations on salaries earned by insurance and managed care executives.

As health care professionals, we believe it is important to share with the public the impact these changes have had on the treatment we offer our patients.

As health insurance policies become more complicated and restrictive, less time is spent in direct care with patients and more time is spent either deciphering the insurance coverage or trying to contact case managers.

As our patients have become more knowledgeable about their health insurance benefits, they are now more angry and frustrated with what they perceive as unfair coverage.

Since the insurance company has become a controlling voice in treatment decisions, the relationship between patient and doctor any other health professional) is now tainted with anger and resentment rather than trust and hope.

What changes do we recommend? We would like the objective of controlling medical costs be a shared treatment goal between patient and doctor.

We would like a new concept of managed care, one which allows the patient and doctor to determine the best course of treatment in the most cost-conscious manner.

In this new vision of managed care there would be no outside "manager," insurance companies would return to the role of insuring (not controlling) medical care, and doctors would again be allowed to devote their full time and attention to providing quality medical treatment.

Anne Stoline, M.D.

Wendy Garson

Towson

Double standard?

Is it true that the Clintons, Congress and congressional aides will be covered under a different health-care plan than the plan which will cover the American people?

A double standard already exists between Congress and the rest of America. Why allow it to continue as new laws are voted into existence?

Please print the names of any groups working for more equity between government and the ordinary citizen.

I am willing to work to make people aware that our taxes are funding a more generous health plan for elite government employees than we will get ourselves.

Evelyn Karnes

Bel Air

Police reforms will hurt performance

Many of Police Commissioner Thomas C. Frazier's initiatives, particularly his decision to decentralize command, appear solid. However, the benefits of such "good calls" will be totally negated by one "bad call" -- his rotation scheme.

Granted, one must provide upward mobility for the talented and weed out the incompetent. But his method will lower the level of performance to the mediocre, because it precludes the use of the exceptionally talented and experienced.

The blanket replacement of the experienced by the less experienced wastes the taxpayers' investment in the training of competent and experienced officers and risks lives in the process.

This scheme will drive out our best while it makes the city and the commissioner himself vulnerable to lawsuits by crime victims.

The commissioner must be selective. That's the method we used to hire him, and we expect him to run his department accordingly.

lizabeth Derby

Baltimore

Food for thought

As a man who lives by the axiom that the only true convenience food is the kind that they bring you in a restaurant, it pains me to admit that the Restaurant Association of Maryland has given those of us who support President and Mrs. Clinton's efforts to reform our health care delivery system a unique opportunity to put our money where our mouth is.

We can demonstrate our disagreement with the association's political actions by not eating in member restaurants.

I've always considered the restaurateur to be the noblest of merchants. They provide not just sustenance, but pleasure and comfort, places to celebrate the best in life.

It hurts to think that men and women involved in such a beautiful endeavor could stoop so low to fight efforts to provide all Americans access to health care.

It hurts to think that this second-rate distortion came from the hearts of the restaurateurs of Maryland. I can only hope that the association's leaders have misread the membership.

Its recent political advertisement attacking the president's proposal drags out the usual conservative distortions. "The government will choose your doctor." Wrong.

For the thousandth time, nothing in the Clinton plan supports that statement. In fact, today my employer picks my doctor, since he picks my health insurance plan.

As to the commercial's cute reference to postal service, ask yourself two questions:

When was the last time the Post Office lost a letter that you mailed? When was the last time your insurance company misplaced your paperwork?

I don't know about you, but my private sector insurance company gives me much more trouble than my government letter carrier does.

ichael Bennett

Baltimore

Vandalism

The citizens who contributed to the Memorial to War Veterans in Curtis Bay, and Milton F. Zientek, the force behind it, are the type of people who made our country what it once was.

The memorial is being desecrated by vandals. Perhaps the answer to the problem would be to let the vandals tear the memorial apart, and put up the following plaque.

"Here once stood a memorial to the War Veterans of the United States of America.

"It has been destroyed by those whose freedom was obtained and maintained by these veterans.

"May the vandals have good memories, because someday they will mature."

Thomas Jefferson once said that people of his generation fought a war so that their sons and daughters may peacefully study to become doctors, lawyers, engineers, etc., so that their children may become artists, dancers, musicians, etc.

We've had our big war and our generation of skilled professionals. The present generation of would-be artists are hooked on MTV, style and doing what Madison Avenue dictates.

Now we have nuclear weapons, which eliminate huge, everybody-pull-together, conflicts. The cycle has been broken.

Wars are terrible things, but they do generate responsibility and maturity.

Charles Johnston

Pasadena

Triumph of pop

In his gung-ho column "The Triumph of Pop" (March 19), Glenn McNatt really whoops it up for America's pop culture, including television, films, records and the blast-furnace intensities of rock and rap that are called "music" in some circles.

He boasts that our pop culture will "go down in history as one of the great creative epochs of all time" and opines further that "pop is a uniquely American creation that has enchanted the world."

Personalities Mr. McNatt names who have "enchanted the world" include Madonna and television's Roseanne (gasp!).

Referring to those two gurus of grobianism as part of a "triumph" is enough to spring a leak in this reader's topside tank.

Wells Mears

Baltimore