Creating a better model for health careI...

THE BALTIMORE SUN

Creating a better model for health care

I am writing in response to the column titled, "A better model for health care," that appeared in The Sun on Sept. 24. In his commentary, L. David Taylor addressed the rise of managed care and the dissatisfaction of health care providers with the current system.

Physicians said that treatment restrictions sometimes conflict with the trained physician's professional judgement.

Concerned that patients are not always receiving appropriate care, some physicians are attempting to form new organizations called physician organizations (POs) and physician- hospital organizations (PHOs). Ideally, PHOs and POs would give the provider the power to determine what services a patient receives while controlling spending.

Mr. Taylor suggests a health care delivery system that he predicts would satisfy the need of both the managed-care companies and the physicians. In his model, physicians who owned the organizations would establish standards for care and have freedom in treating, while their counterparts, the insurers/HMOs, would handle controlling costs.

As an occupational therapy student, I wish to respond to Mr. Taylor's plan, as I feel it would impact the delivery of occupational therapy services. While I support the union of health care providers and managed care organizations, I do not believe that physicians should be exclusively responsible for setting standards for care.

Physicians are not the only health care professionals who are given restrictions. For example, often services provided by occupational therapists are indicated much longer than they are paid for by insurance.

Also, to allow physicians to exclusively set standards of care gives them a power that could negatively impact the delivery of other health care services. Financial incentives, hypothetically, could make the treating physician less likely to refer to specialized professions.

My proposal is for a system that unites managed care organizations and health care providers. One change I would make to Mr. Taylor's plan would be to have representatives from each of the health care professions who provide services under the insurance plan contribute to the development of standards of care and be given freedom to use the skills for which they have been formally trained.

Amy Landemare

Annapolis

Students put on a great show

Something wonderful happened in Anne Arundel on Dec. 14, when some of the finest talent in young musicians gathered to present a concert. Not publicized greatly, this event was one of the most outstanding presentations of music we have ever heard.

An orchestra of some 97 young people from the sixth, seventh and eighth grades joined their talents under the direction of Chris Allen to present a musical night to remember. Concluding the evening was the All-County Senior High Orchestra, under the direction of Harry John Brown.

We praise the music teachers and departments that assist in preparing these students to play such wonderful music and excel at such a young age. Anne Arundel County schools should be proud of this achievement. The nearly 600 in attendance at Lindale/Brooklyn Middle School would agree. Bravo, students.

Robert and Signe Worsham

Millersville

Vice doesn't follow flag; prejudice follows the writer

In his Dec. 3 op-ed piece, "Vice follows the flag," Llewellyn H. Rockwell Jr. displays a shockingly narrow-minded and prejudiced view toward enlisted members of our nation's military.

In one fell swoop, he managed to twist together the facts surrounding a single incident of rape, along with several dubious assumptions, and slander millions of present and former service members in the process. Many of whom, by the way, make profound personal sacrifices (including the ultimate) in service to our country.

In support of his assertion that "the military attracts social misfits and deviants," Mr. Rockwell offers several pieces of evidence, including the rape of a young Okinawan girl by three U.S. servicemen and the public outcry which understandably followed; the existence of "an entire city of bars and prostitutes" near our previous U.S. Naval Base in Subic Bay, Philippines, and the existence of "two dozen or so nude dancing" bars near Fort Benning in Columbus, Ga.

Rape is a terrible crime, and the three soldiers responsible were rightfully prosecuted and punished under Okinawan law. But should the crimes of a few reflect on all 1.4 million people in the military? How would Mr. Rockwell respond if someone were to impugn the entire citizenry of Auburn, Ala., for isolated misdeeds committed by three local criminals? That's the type of logic upon which his reasoning is based. It just doesn't wash.

Further, I submit that the nude bars and prostitutes he refers to exploit and victimize soldiers and sailors, rather than the other way around. They prey on naive young men who suddenly find themselves far from home, usually for the first time. Those bars and hookers, both in the U.S. and abroad, try and lure in lonely young men and relieve them of their hard-earned cash. It has nothing to do with morality, and everything to do with immaturity and inexperience. If there were huge, predominantly male college campuses located in small towns, and the young students were paid a salary, the same type of seedy nude bars would no doubt exist nearby.

Considering the deluge of negative publicity surrounding recent incidents of sexual assault and harassment "scandals" in our services, it is understandable why a writer would jump on the military bashing bandwagon. Sex and violence is easily sensationalized, and it sells.

Tom Barkwell

Severna Park

I am an officer in the U.S. Army with almost 25 years of active service, so I am less than objective in my feelings for the author's viewpoint. As you might expect, I take exception to many of the opinions he expresses, some of which he misrepresents as facts.

First, I agree with Llewellyn H. Rockwell Jr. that the conduct of the U.S. Marines who raped the young girl in Okinawa was reprehensible. They have been tried and punished under the law, as they should have been. Why the incident should cause the "public to rethink the place of the U.S. in the post-Cold War world" is beyond me.

Mr. Rockwell's assertion that, "alcoholism is rampant and so is drug use" is preposterous. The armed services have the same alcohol problems as the society they serve. In the military, a single alcohol-related incident such as driving under the influence will effectively end a service man or woman's career, regardless of rank. The military also maintains a zero-tolerance policy toward drug use supported by an aggressive random drug-testing program. There are no second chances.

The young men and women who serve their country in the Armed Forces are the finest in our history. They are smart (over 90 percent high school graduates), motivated and professional. They are not perfect, but they are definitely not wreaking "moral havoc on foreign lands." Americans can be justly proud of the military that serves them.

John F. Johnson Jr.

Fort George G. Meade

At first glance, I had to agree with Llewellyn H. Rockwell Jr.'s column, "Vice follows the flag." Before my husband retired from the military, we traveled extensively throughout Europe and found that if any specific group consistently displayed loud, rude, obnoxious behavior or an arrogant attitude, it was Americans.

However, I have to take exception to the way that Mr. Rockwell foists the blame on the American military. He states that the military "attracts social misfits and deviants" and that "alcoholism is rampant and so is drug use." He goes on to blame the American military for the blight of crime, drugs, pornography and promiscuity in areas where we have established military posts.

These institutions that cater to the baser side of human nature are owned, operated and promoted by locals, whether in America or abroad, who have obtained the blessing of the community either through zoning and licensing, or the willingness of law enforcement to look the other way.

And never, after 20 years in the military or since, have my husband or I ever witnessed the American military acting as "the world's largest purveyor of pornography, which pours out of its discounted PX shops," as Mr. Rockwell charges. It is quite obvious to anyone who has ever held a military ID card that he's never set foot in one.

After a lengthy stay in Europe, we experienced a greater cultural shock upon returning home than we had ever experienced abroad. The Americans we had seen displaying obnoxious behavior overseas, both civilian and military, were on television, in commercials, in the stores and on the streets. And our society has given its tacit stamp of approval to this behavior by not only ignoring it but by fighting for its "right" to be obnoxious and uncivilized. So, what do we expect?

If Mr. Rockwell wants to root out the cause for such behavior and restore a semblance of decency to our society, perhaps his tirades would be better channeled to the lack of parental responsibility, the failure to teach discipline and the loss of decent human behavior in his own town, state and country. The military of any country reflects the society from which it springs. It is comprised of adults who were raised either with or without standards of self-discipline, moral conscience and appropriate human interaction. If these traits are absent, it is only because the military can't be expected to undo the damage done by years of lazy, neglected, ignorant, absent and uncaring parents, or by a society that condones its own lack of discipline and decency.

J. L. Payton

Pasadena

Pub Date: 12/29/96

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