Some Health Reform Proposals Hurt HMOsWe know...

THE BALTIMORE SUN

Some Health Reform Proposals Hurt HMOs

We know that the people of Maryland have heard from many physicians regarding their views on various health care reform proposals. Many of those views are from the perspective of physicians who seek to protect their fee-for-service practices from the increasing success of managed-care plans.

As one of the health providers that pioneered community rating, preventive care, health education and comprehensive coverage, we are deeply concerned that advancements in medical care delivery may take a frightening backward step because of some proposals currently before Congress.

We are the physicians who provide care to members of the Kaiser Permanente Medical Care Program, the non-profit prepaid group practice health maintenance organization.

As physicians who live and work in the Baltimore metropolitan area, we believe that others may be interested in our unique perspective.

We are deeply concerned about health care reform provisions or amendments that would interfere with the ability of HMO physicians to coordinate care and choose fellow providers based on quality and the needs of our patients.

Such provisions would require HMOs to develop the characteristics of an indemnity insurer. HMOs offer consumers another choice besides fee-for-service and indemnity models. Our patients should not be deprived of the ability to choose coverage under a classic HMO model.

The proposals include:

* "Any willing provider" provisions requiring an HMO to accept providers in a service delivery system.

As a prepaid, group model HMO and a provider of medical care, Kaiser Permanente determines the number and type of providers required to serve the needs of our members based on utilization of medical services by our members.

In addition to limiting the ability of an HMO to control costs and monitor quality, it will force us to develop a claims paying capacity that we do not currently need. It will also make it difficult for us to provide continuity of care to our patients and would compromise our ability to work with providers who match our high-quality standards.

* Provisions requiring HMOs to contract with hospitals affiliated with medical schools and academic medical centers.

These provisions make the incorrect assumption that the quality and range of services provided by such facilities is superior to others. Kaiser Permanente provides excellent, quality medical care through its own facilities and through contracts with other facilities, some of which are academic medical centers.

Requiring HMOs to contract with academic medical centers provides them with a guaranteed source of revenue without making them subject to the competitive forces of the marketplace.

Contracts with other providers for specialty services should be based on demonstrated quality, rather than artificial designations.

The hospitals that we affiliate with also go through our rigorous appraisal. To assume that all academic medical centers offer superior quality and range of services does a gross injustice to us and to our affiliated hospitals.

* Proposals requiring HMOs to offer point-of-service coverage. Organized, integrated health care delivery systems such as Kaiser Permanente should not be required to adopt indemnity-like practices.

By requiring equal or greater coverage than indemnity coverage, the impact of these provisions would be to encourage individuals who never intend to use the HMO's services to select an HMO point-of-service option simply to obtain the lower rate.

The purpose of point-of-service plans in the market today is to introduce enrollees to the advantage of an HMO while providing the security of an out-of-plan option as an alternative. If HMOs are required to offer point-of-service plans, there will be no incentive for an individual to share responsibility for appropriate use of health care resources.

The impact of the provisions we have described above would be to increase our costs -- and, therefore, our premium rates -- by as much as 25 percent.

The millions of Americans who have elected to obtain their health care through HMOs -- and the hundreds of thousands of employers who help them pay the premiums for that coverage -- will feel angry and betrayed should "health care reform" result in such a significant increase in their costs.

We know that other Marylanders will be as alarmed as we are that we could lose the great gains in medical quality and cost-effectiveness that have been accomplished by health care delivery systems like the Kaiser Permanente Medical Care Program and the impressive health care reforms already achieved in Maryland.

Adrian E. Long, M.D.

Woodlawn

The writer is physician-in-chief for Kaiser Permanente in Baltimore. Twenty-three other Kaiser Permanente physicians also signed the letter.

Gun Advocates Worry About Wrong People

I can't help wondering if Peter Jay's column "It's Easier to Disarm the Law-Abiding" (Opinion * Commentary, June 2) distinguishes between attacking the scientist because you can't dispute the science -- which his piece disparages -- and attacking an idea not advocated because you can't attack the one that has been.

Mr. Jay assures us that what gun controllers really want to do is "eliminate all firearms from American life," blithely dismissing the fact that this objective is "routinely denied."

He then devotes the rest of the piece to the difficulties of doing what gun control advocates deny doing.

The fact is that gun control advocates are troubled by the quite legitimate question: "How do you bar gun ownership in a nation in which 250 million people own some 200 million firearms . . . ?"

The answer, of course, is that you don't. Which happens to be why we "routinely deny" urging any such thing.

But the question neatly poses the issue that does bother us: How do we deal with such an immense and lethal arsenal in our midst?

The central issue, to many of us, is precisely that sheer immensity. With that number of deadly weapons scattered about the American landscape, how can you possibly operate any common-sense mechanism of accountability and control?

How do we keep them out of the wrong hands -- meaning not just violent felons but, for instance, children, bullies, psychopaths and angry spouses? Is there any practical way that doesn't involve reducing that massive total to some manageable and well-considered level?

With the widespread ownership of guns in America, it is no coincidence that the number of gun-related deaths are just as enormous -- and that the numbers exceed those in other developed societies.

The specific type of guns -- "assault guns" -- does not wholly

define the issue.

But you can't have it both ways. You can't fault gun control advocates for "really" trying to ban all guns and also for defining the limited area of gun ownership that they genuinely seek to control.

Kenneth Bache

Annapolis

There is a group of people in this country who are more worried about the rights of criminals than they are with your personal safety.

This group is so worried about the civil liberties of these lawbreakers they spend millions, with much of the money going to the re-election campaigns of many of our representatives, to defend them from the majority of Americans who want those lawbreakers locked up.

These people adamantly refuse to compromise because they are afraid of losing their "constitutional rights," even though more than 10,000 people a year lose their lives to the criminals they protect.

I'm not talking about the American Civil Liberties Union or some left-wing group, I'm talking about the National Rifle Association and its supporters.

These sheep in wolf's clothing, talking so tough when discussing possible solutions to our crime problem, are in fact being soft on people who have no understanding of the value of life.

Peter Jay in his June 2 column makes the absurd argument that enacting laws will not stop someone from getting a gun.

If this is the case, then why have any law when, after all, if someone wants to break it, they will do so despite any prohibition?

Although he admits that the British successfully outlawed guns, with the result of a much safer nation than ours, Mr. Jay does not think it would work here because "most of us are highly law abiding, but we live in a society that isn't."

If we are so law abiding, then why isn't our society? The answer is we are not.

We Americans support our criminals. Many of our movies and TV shows are about them, often making killers into celebrities. Despite the fact children are being murdered daily, we continue to allow them to buy guns easier than I can buy a new car.

One reason it is so easy to commit a crime and get away with it, is because no one will inform on criminals.

Many "law abiding" citizens know violent people who own guns, yet stay silent because they in fact admire those nut cases, viewing them as tough, cool, "real" men.

It is about time we stop coddling violent people who are allowed to own almost any gun they want.

Mr. Jay, Rep. Roscoe G. Bartlett, Rep. Helen Bentley, the NRA and others should stop defending people who own guns for no other reason than to kill, maim and terrorize others.

Surely some people will suffer the loss of their precious weapons, but much more importantly, we will save the lives of thousands of innocent American men, women and children.

Joseph G. Otterbein Jr.

Baltimore

True Villains

Regarding the Opinion * Commentary column May 31 by Richard Reeves entitled "Making Nikes for $35 a Month, Less $7 for Board": The story behind the headline would take much more than a short letter to analyze.

However, while I agree that everything said in the column is true, I must disagree with his version of the villain, i.e., "the greedy bosses and greedier foreign investors."

The true villains are you, me and Richard Reeves, because without us in this country who are willing buyers of items made under these conditions, they would not exist; therefore, no greedy bosses or greedier foreign investors.

Oscar Schabb

Brooklandville

Foreign Aid

Your April 25 editorial, "Foreign Aid for Our Time," noted that our 33-year-old, Cold War-driven foreign aid law is in bad need of reform. You urged Sen. Paul Sarbanes, D-Md., who chairs the Senate subcommittee responsible for this issue, to shepherd foreign aid reform legislation through the Senate this year.

On May 20, Senator Sarbanes released an excellent draft bill that would overhaul the entire U.S. foreign aid program.

Mr. Sarbanes' bill makes a number of improvements over the administration's proposal on which it was based.

Senator Sarbanes has put more emphasis on investments in children, primary health care, nutrition, basic education and other poverty-reducing strategies.

He has placed higher priority on human rights and established stricter human rights conditions on aid.

The Sarbanes bill would coordinate economic aid programs and make sure they all foster just and environmentally sustainable development. It would provide humanitarian aid, without discrimination, on the basis of need.

The Sarbanes proposal would also make foreign aid more accountable to Congress and the U.S. public.

Senator Sarbanes deserves credit for producing such a forward-looking and responsible foreign aid reform proposal while in the midst of a difficult race for re-election . . .

David Beckmann

Silver Spring

The writer is president of Bread for the World.

Black and White

I am a "white" inner-city resident who usually follows Gregory Kane's columns with interest and appreciation. I was disturbed, however, by his May 24 column about inter-racial romances.

Mr. Kane wrote approvingly of the decision by Principal Hulond Humphries of Wedowee, Ala., to ban interracial couples from the Randolph County High School prom.

While I understand both Mr. Humphries' and Mr. Kane's desires to avoid the inter-group tensions that such dating usually creates, I cannot support a position that judges the suitability of a romantic partner on the basis of skin color.

My best friend, who is also "white," has been romantically involved with a thoroughly "black" man for about two years, and I have never seen her happier.

They have a relationship characterized by mutual kindness, honesty, open communication and service to the larger community.

Of course, like everyone else they have problems to deal with, and for them there are the extra problems created by people who see skin to the exclusion of character or personal worth.

But my friends help each other to face racist, exclusionary

attitudes and practices. Neither of them has any desire to give the other up because of other people's bigotry. I can only hope that my children will find such committed and caring partners, no matter what their skins look like.

Christine M. Du Bois

Baltimore

Victim of a Hoax

Thomas E. Maloney's May 28 letter shows him to be the victim of a widespread hoax.

Mr. Maloney refers to Handgun Control Inc.'s alleged secret and confidential plan to -- among other things -- eliminate all private gun ownership in the United States. The document is bogus, fake, a lie.

We support common-sense restrictions on the way that guns are bought and sold in this country. Nothing we espouse would prevent a law-abiding citizen from purchasing or owning a weapon if he or she so chooses.

The measures that are included in our comprehensive legislation -- the Gun Violence Prevention Act of 1994, known as Brady II and introduced in Congress Feb. 28 -- are designed to reduce gun violence and save lives by cutting off the flow of weapons to the illegal market.

Those measures include licensing of handgun owners, registration of handgun transfers and mandatory safety training,

Let's face it. We have a serious crime problem that has only been made worse by the easy availability of guns.

Today, Americans don't fear being mugged or robbed, we fear being shot. Shot for driving too slowly, for not giving up our valuables fast enough or for just being in the wrong place at the wrong time.

Cheryl Brolin

Washington

The writer represents Handgun Control Inc.

Teaching Sex

Teaching your children about sexuality does not have to be traumatic, as Susan Reimer suggests in her May 19 column.

In fact, the experience provides an ideal opportunity for families to open lines of communication and address real life issues with honesty and sensitivity.

Ms. Reimer noted that taking the first step to talking about sexuality with your children is often the hardest.

What she neglected to remind readers of are the community resources available to help parents speak openly about sexuality.

Organizations like Planned Parenthood provide parent/child workshops and offer a variety of materials to make the experience a learning and growing opportunity for the entire family.

As a health educator for Planned Parenthood, I share these hints (and many more) with concerned parents:

* Begin to open the lines of communication with your children as early as possible. Starting with the little things ("How was your day?" "Listen to how mine was.")

* Don't always wait for your children to come to you with questions. Take advantage of "teachable moments."

* Teach your children the correct names for their genital organs just like you teach them the correct names for eyes and ears.

* Don't feel that you have to have all the answers all the time. If you do not have the answer to a question, admit so. Then suggest that you seek out the answer together.

* Take advantage of your local library (there are books for every reading level), your pediatrician, your friends and Planned Parenthood for resoures and helpful information.

* Spend not only family time with your children, but also individual time with each child away from the rest of the family. Make a date, on a regular basis, that you both keep.

* Share past experiences and mistakes with your children along with your values and hopes for them. Admitting that you were not and are not perfect gives parents credibility and increases the likelihood that your children will share concerns and experiences with you.

By the way, these are the same hints I used when talking about sexuality with my eight-year-old daughter.

No, it wasn't easy taking the first step. But it also was not traumatic. It was honest, caring and the right thing to do.

Deidre Curry

Baltimore

The writer is education coordinator, Planned Parenthood of Maryland.

New Market

I am a resident and a voter in the area of Charles and 25th streets who strongly supports the proposed Safeway supermarket for our neighborhood.

The opportunity to shop for food and related items in a new and clean environment with very competitive prices is something that I am eagerly looking to in the near future. It is my understanding that more than 100 new jobs will be created in our community.

To those from outside our neighborhood who want to save long-vacant, boarded-up buildings loaded with asbestos and rats, I say leave us alone.

Mr. Mayor and City Council members, I say the sooner the better.

Ida Blair

Baltimore

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