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An Unheard Voice on Health CareAs health...


An Unheard Voice on Health Care

As health care reform hits the House and Senate floor in July, I will be opening a solo dermatology practice in Havre de Grace.

Among the resident physicians completing training this year at the University of Maryland, I am the only one I know who is daring to undertake the start-up of a new medical practice. I am of the unspoken generation of physicians -- you probably have not heard from many of us. We are a small political voice, so involved with surviving the rigors of medical training that we too rarely take the time to write or call our political representatives. Yet, we are the physicians who will ride the turbulent waves of health care reform with you. You should therefore know who we are.

I am 34 years old, a graduate of a fine American education -- Yale College, Case Western Reserve School of Medicine, University of Maryland Dermatology Residency. Like most physicians, I have had more than 12 years of post-high school training. I have never made more than $31,000 a year. My wife, 33 years old, is an internist in her second year of practice with a large managed care organization in Harford County. Our combined educational debt was initially over $100,000.

Currently, we owe $70,000 in outstanding educational loans. We pay $1,378 a month in loan repayments, which is $200 more than we pay for our townhouse mortgage. To start my dermatology practice, I have borrowed an additional $20,000 from a local bank.

The educational debt weighs upon us heavily. We are not extravagant people. We drive 1984 cars without air conditioning. We have no credit card debt and pay all our bills promptly. Yet, even with the current (but soon to end) security of my resident salary, we are just able to make ends meet. We would like to have a child soon, but we worry about being able to afford to do so.

Am I bitter? Resentful? Somewhat. I paid the Cadillac price into a system that now promises Pintos. Mind you, I'm not pleading poverty. I am certainly aware of the many who are less fortunate. And I realize that someday I may be able to look back on these as "the difficult times." But these times are difficult now.

I know that you have heard from other physicians that the bureaucracy, the paperwork, the governmental "intrusions" into their daily practice has been a great source of bitterness and frustration. I have no way of describing to you the impact of such a barrage of regulatory forms, fees and checklists upon a physician just starting out.

In the past six months, the hours (and dollars) I have put toward jumping through regulatory hoops are truly incalculable: CLIA, OSHA, federal DEA, Maryland DEA, the state licensing board, Medicare, Medical Assistance, two dozen insurance and managed care companies -- all require extensive "credentialing." CLIA additionally requires that I pay an annual fee to an agency which will then periodically come to my office to fine me for various infractions of detailed and constantly changing rules. What this means for me is that I've had to hire a secretary for six full weeks before I actually set foot in my office, just to push through the paperwork maze. I fear, as my more seasoned peers tell me, that this is just the beginning.

I hope that Congress considers the situation of young physicians like myself in the upcoming months. In the highly politicized construction of a new health care system, the hopes, issues and real needs of our country's next generation of physicians are being passed entirely by. Quality of care gets some lip service, it seems, but no real priority in these health care discussions.

Dr. David F. Jaffe

Havre de Grace

Reality Check on Health Care

The Clintons, senators and House members intent on ramming through health care need a reality check.

The true costs of any plan with employer mandates and universal coverage will be fewer jobs, higher prices, another parasitic bureaucracy and rising debt.

They'll fall on a citizenry already paying through the nose for social programs and too much government. Consider these real people:

A farm laborer supporting a wife and child on $6.20 an hour who had $53.98 withheld last week, losing 16 percent of his pay.

A supermarket cashier who found that taxes, Social Security and Medicare take her wages for "Sunday plus a half-day" and told a customer she's fed up with working to pay for those who won't.

A small business manager doing hazardous work who sent the government 54 percent of his 1993 earnings and now says he'll vote against all incumbents.

Mignon A. B. Cameron

Bel Air

Child Care

One of the most attractive qualities of the Harford County area is that it is a family-minded community. In accordance with that, child care is a priority within this area. The YMCA of Greater Baltimore recognizes this need for quality child care at an affordable rate and is proud to have been offered the opportunity to provide superior child care through the YMCA Campus Child Care Center on the Harford Community College campus. . . .

The YMCA signed the contract with Harford Community College on June 17, and will take possession on Tuesday. To show its commitment to the facility, the YMCA will be moving the entire Harford County Child Care Administration to the center. . . .

The YMCA is the largest non-profit provider of child care in the country. When it started out in Harford County six years ago, it had an enrollment of 50 children and now is serving more than 1,000 children daily. . . .

Beth Saverino


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