Paying Bills

Amy Donohue blames insurance companies for scuttling health care reform in Congress and for the health care "crisis" generally (letter, Sept. 18). I have seen many such letters in various papers over the last year or more, and their writers all have one thing in common: They have forgotten the purpose of insurance.

Insurance companies were set up in order to spread the risk of financial disaster out among a large group of people. Those people, having paid a modest fee or premium, got in return a guarantee of financial security if faced with, say, medical bills they would not ordinarily be able to pay on their own.

Unfortunately, that straightforward notion of insurance has been obscured and corrupted by our insistence that such insurance cover routine expenses as well. We have forgotten that it makes no sense to pay an insurance company to pay such small bills. If one can reasonably foresee that one's medical expenses in a given year are going to be, say, $1,000 for doctor's visits and medication, what sense is there in having one's insurance company pick up the tab?

One of the economic facts of life in this world is that there is no such thing as a free lunch. Everything that we acquire or consume has to be paid for, one way or another. There being no free lunch, the insurance company has costs it has to pay in order to process one's claim, such as the wages and salaries of its clerks and agents, its rent, its electric bill, et cetera. The end result is that the insurance company spends, say, $1,500 to pay the $1000 in claims. Where is the insurance company going to get that $1,500? Through an increase in one's premium. Surprise, surprise!

Wouldn't it make more sense to pay the doctor the $1,000 directly? It's cheaper.

Given our perception, made possible through overuse of insurance, that "someone else" is paying our medical bills; given needlessly high doctors' fees, made possible through our insistence on licensure laws which give doctors a monopoly in medical practice; and given our government's intervention in the form of tax breaks and subsidies which distort the market in health care, is it any wonder our health care system is seriously out of whack?

In short, we the people, not an evil conspiracy of insurance companies, are responsible for the ills of our country's health care system.

mos Hale Adams

Baltimore

Sauerbrey Insults

Delegate Ellen Sauerbrey, the Republican nominee for governor, is insulting the intelligence of every Maryland voter with her promise to cut taxes by 24 percent and provide tuition vouchers for private school students. Apparently she is relying on the supposed short-term memory of voters who do not remember when Gov. William Donald Schaefer tried to cut the budget and provide tuition vouchers. I remember, and I know others remember as well.

Whose oxen is she planning to gore to achieve such a tax cut? Yours, mine or all of ours? Are local governments to increase the piggyback and property taxes to make up for the loss of services? How is she going to do this? Does she think her salary as governor is approximately 24 percent of the state budget?

With regard to tuition vouchers for private school students, she is advocating Parochaid, i.e., aid to parochial schools, voted down in referendum by Maryland voters in 1972 and 1974. Basically, the voters said that it is wrong for government to compel people through taxation to contribute to the support of religious teachings, programs or institutions which they do not individually choose to support voluntarily. The voters knew then and know now that over 90 percent of non-public enrollment is in schools operated as independent institutions primarily for denominational religious purposes, in which curricula are permeated by a denominational point of view.

Persons of one particular faith should be free to use their own funds to strengthen the belief system of their particular religious group. But they should not expect all taxpayers, including those who adhere to other religious beliefs systems, to provide funds to teach religious views with which they do not agree. There is no more basic American principle than that all individuals be free to support only those religious institutions or enterprises they wish to support.

There is also the obvious violation of the First Amendment that would be encountered with the voucher proposal/promise. Does candidate Sauerbrey think that voters are really that ignorant of the principle of separation of church and state? They weren't in ++ 1972 and 1974, and they aren't now!

an Bridgewater

Westminster

Hospital Expenses

The article about David Giggard (Sept. 22) and his wait for a liver transplant told an important and most welcome story about the need for organ donation.

One point in the article, however, needs some clarification. Readers may have been left with the impression that Mr. Giggard is without full coverage for his medical expenses. In fact, he is covered by Medicare and Medical Assistance of Maryland (Medicaid). Medicare is the primary payer and is expected to pay the initial expenses for liver transplantation except for any applicable co-pay and deductibles. Medical Assistance will cover those expenses.

Also, in the event that Mr. Giggard exhausts his Medicare coverage, Medical Assistance would become the primary insurer and cover all costs related to organ transplant. This includes all post-transplant medical care, including drugs. In summary, the patient should not incur any out-of-pocket expenses directly related to his hospitalization or medical care. There are, of course, living expenses not covered by any health insurance program for which the family may need assistance.

Joann Rodgers

Baltimore

The writer is deputy director of public affairs, the Johns Hopkins Medical Institutions.

Good Teachers

The members of the Public School Administrators and Supervisors Association (PSASA) were not surprised that more than 90 percent of Baltimore City's teachers were rated satisfactory or better.

Our city schools have fine teachers, professionals with more ability than they are often credited with having. The members of our association know this well for they work every day in the schools, in partnership with teachers.

Our members are the principals, assistant principals, directors and specialist who nurture our teachers, support their efforts, and expand their skills through professional development.

Even with the current instrument, our observation and evaluation objectives are to improve the quality of instruction, keep our teachers up to date on new techniques and stretch our teachers' talents. We consistently search for strategies to enhance teacher performance.

Sheila Z. Kolman

Baltimore

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The writer is president, PSASA.

Dunbar Myth

In a Sept. 20 letter, Samuel L. Banks promotes the myth that Dunbar High School is a center of academic excellence. To refute this claim, I ask how many Dunbar graduates have been admitted, during the past 10 years, to Harvard, Princeton, Yale, MIT and Brown?

The number of such students is extremely low, particularly since the five schools combined have admitted about 50,000 during this period.

Apologists for Dunbar argue that the cost of attending these schools is prohibitive, for most inner city residents. This argument is refuted by the fact that each college will provide any qualified applicant with an individual package of financial benefits sufficient to guarantee attendance.

Paul Slepian

Baltimore

Bus Seat Belts

We read with frequency letters to the editors suggesting ways to make school bus transportation safer. The letter of Caleb R. Kelly Jr. (Sept. 17) is an excellent example. We hear of innovations to this end tried throughout the country. One school district has installed TV cameras in its buses in an effort to control the rowdiness of the energetic young passengers.

The most basic solution seems to have eluded those who express such concerns. And although there might be compelling arguments against it, we wonder just why such buses are not equipped with seat-belts.

Today's children tell us they are more comfortable wearing a familiar belt. They are used to them and feel awkward in their absence. And the habit should be encouraged! Not having them in their bus sets a very poor example.

In addition, seat belts keep those who are wearing them seated and let the driver know who is restrained and who is not. He knows that a seated child is not only safer but less able to cause mischief than one unfettered.

Finally, school buses do occasionally have accidents and children are often the victims. The Snell Foundation along with Cornell University 50 years ago declared that the chance of being trapped in a fire was minimal when compared to the frequency of an accident in which the wearing of a belt could save lives.

What more effective and economical solution to school bus rowdiness exists? More important, what better method of protecting the dear ones from unnecessary injury?

Dick Ballard

Sparks