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Would a one-payer health plan work?Ronald Dworkin's...

THE BALTIMORE SUN

Would a one-payer health plan work?

Ronald Dworkin's column "Beware one-payer health insurance" (Opinion

Commentary, Aug. 24) was noteworthy for what it didn't mention.

The writer expressed concern for young adults who could be forced to take advantage of employer-sponsored health insurance under a "single-payer" system, rather than opting for being uninsured and having higher wages.

Not mentioned was the plight of hundreds of thousands of Marylanders who are forced to be uninsured or under-insured -- even in these prosperous times.

And the "market-oriented reforms" that the writer supports are typically little more than tinkering around the edges of a health care non-system in disarray.

The Maryland Health Care Commission's 2000 report found that more than half the uninsured live in families with two or more employed adults. Most of them are people in low-paying jobs who are not offered coverage or simply cannot afford the premiums.

The World Health Organization's 2000 report evaluated countries' health care systems based on life expectancy, efficiency and equality of the system and how it responds to the social and financial needs of its citizens. Although we spend more on health care than any other country, the United States ranked 37th.

Canada rated significantly higher in nearly every category.

The United States also has the distinction of being only one of three countries in the industrialized world not assuring health coverage for its citizens, along with Mexico and Turkey.

A truly reformed health-care system must streamline the administrative burden of numerous insurance companies, each with its own maze of benefit rules, referral and authorization processes, billing procedures, forms and marketing, lobbying and profit motives.

A more rational system would generate enough savings (conservatively estimated in Maryland to be half a billion to $1 billion annually, depending on the reforms) to allow affordable, comprehensive coverage to be extended to all citizens, regardless of employment, economic or health status.

Mr. Dworkin exalted more market competition among insurers as the key to better care.

I believe a streamlined system would encourage competition for quality care among physicians and hospitals, rather having insurance corporations compete on the basis of stock prices and profits.

Dr. William Sciarillo, Baltimore

The writer is the president of Baltimore HealthCare Access Inc.

Ronald Dworkin is right on the mark in warning of the perils of a single-payer health insurance system for Maryland.

That health insurance reform is sorely needed appears beyond dispute. The old indemnity system, Hillary Clinton's failed health-care overhaul, present-day managed care -- all of these approaches have been either too expensive, too short on quality or both.

Yet the problems inherent in correcting our system or in crafting a new one are complex. A single-payer system appeals to us because of its apparent simplicity and we, collectively, long for an uncomplicated solution.

Don't be fooled, though. A one-payer system would bring with it the worst of what we've seen with managed care -- an impersonal bureaucracy, unresponsive to the needs of individual patients.

And, in such a monopolistic system, there would be no incentive to decrease cost or increase the quality of care. Only a free-market system generates these incentives.

The single-payer system is indeed well-intentioned, but we would be better off focussing on removing the perverse economic disincentives which currently permeate the health care market.

Free market reform, which restores the primacy of the physician-patient relationship, is the way to go.

Dr. David F. Jaffe, Havre de Grace

Dispersing the poor is no solution

Donald Norris is absolutely correct when he states that "policies need to be adopted at the state and regional levels to reduce the proportion and concentration of the poor who live in the city" ("Addressing Baltimore's population meltdown," Perspective, Aug. 20).

However, his proposed solution -- dispersing poor people throughout the area -- would do nothing but spread the "social pathologies" Dr. Norris looks to correct.

Such a plan would destabilize neighborhoods and destroy neighborhoods already on the edge.

Historically, the idea of moving low-income families into stable or higher-income neighborhoods has been unsuccessful. Residents of Dundalk, for instance, howled when they heard the "Moving to Opportunity" program would bring low-income city residents out to Baltimore County. The pilot program had to be shut down.

And I can personally attest that that such programs do not work. My block in Highlandtown has recently received several families decentralized from public housing.

With little or no experience of living in a community outside public housing, these families have neither the ability nor desire to obey the community's standards.

They are destroying the sense of community that has taken us generations to build. Indeed, we are no longer a community; we are in a defensive position.

And we are holdouts. Suburbanites have already voted against such programs with their feet. It would be nothing for them to move again.

Anyone saying that poverty dispersal is for the good of the entire region will be talking to the backs of heads, as suburbanites climb aboard their SUVs and depart for more homogeneous pastures.

There is no merit in offering such unworkable solutions. We must have the courage to offer policies that will work. Otherwise we will just be rearranging deck chairs on the Titanic.

But there are people who want to return to the city and are looking for opportunities to do so. And this city has responded exceptionally well to plans that create an environment for investment, whether urban homesteading programs in Federal Hill or historic districts in places such as Fells Point.

These programs have lifted communities from inside without ruining the neighborhoods surrounding them.

This new urban renewal can be instituted without the "Slum Clearance" and "Negro Removal" of the past. We, as a city, can rebuild the social fabric of communities in need by using existing networks within those communities.

We should combine that with enticing new investment in successful homesteading and historic programs. Bring in the people who want to come. Keep the people who want to stay. Do not liquidate. Do not spread. Do not destroy.

The city and state administrations must use the resources and experience we have to resurrect our communities -- not to spread the problems more widely.

Raymond Dubicki Jr., Baltimore

Preserve Woodberry Forest

While The Sun's article concerning the development of the Woodberry Forest attempted to be even-handed, it was also notable for what it didn't include ("Stepping up their fight to save a city woodland," Aug. 14).

First, while the article noted that the Loyola College and Mass Transit Administration (MTA) projects each take parts of the forest, it did not mention the recent building of a retirement community by the now-defunct Children's Hospital, which also took a few acres of the forest.

Also missing were the plans by the Kennedy-Krieger Institute to expand its parking facilities and playing fields, which will take another small chunk.

Indeed, at least five development projects are under way, each proceeding independently and each taking its share of the forest.

Very few people in the community oppose parking for a light-rail station. Opposition to the project concerns the size and construction of the lot. The MTA's stated reason for its large size is to service commuters coming from out of town. Yet it seems unlikely that a commuter, after fighting traffic from the suburbs, will get off the expressway just before his or her destination to take a slow, single-tracked light-rail ride.

Until double-tracking is finished, commuter traffic will not increase appreciably -- and completion of that project is years away.

Why, then, the community wonders, can we not wait to see where and how transportation needs should be met for both commuters and the local citizenry?

An overall plan for the Jones Falls corridor is being developed. Let's see the plan before making decisions on the placement, size, design and safety of a parking lot.

But it is the Loyola College project upon which most opposition centers, because it is by far the largest and will, by itself, change the character of the area.

The article mentioned that a large playing field is being built. It should have noted that the college also plans to build a 6,000-seat stadium, plus other smaller fields, buildings and parking lots.

It is true that Loyola has scaled back the number of fields and parking. But despite compromises around the edges, the size of this project will prevent the area from ever functioning as a real forest.

While trying to preserve the oldest trees is commendable, isolated groves of trees do not constitute a forest in terms of wildlife cover, air cooling and water-filtering.

And of course no new trees will ever grow again on the acres of concrete and playing fields.

The amenities that the forest provides have kept me in the city for the past 25 years: red-tailed hawks by day and great horned owls at night, a cool forest breeze while listening to wood thrushes, tree frogs and cicadas.

If I have to trade this in for the sound of air horns and cheering and a halo of stadium lights, it won't matter what compromises Loyola has made. The area will have changed forever for the residents of the forest and for the people who live around it.

While I can move elsewhere, the city will have lost the services of cleaning the air and water that the forest provides for free -- and it will have ratcheted down the quality of life one more notch.

Jim Emberger, Baltimore

A better way to reach the beach

To facilitate summer travel to Ocean City, Maryland should consider waiving the toll charge on the Bay Bridge on weekends. We already benefit time-wise from toll booths charging only one way. Why not make it both ways?

Sure, the state would be losing a lot of money, but let's be creative and see if this can be done.

Let's assume there are 100,000 cars going to Ocean City each weekend in the summer and that the summer season lasts 10 weeks.

That would be 1 million cars at a toll of $2.50 -- resulting in a total loss of about $2.5 million for the state (the actual figures may be somewhat larger or smaller).

But what if we could get one of Maryland's dot-com companies to cover this loss? Appropriate billboards on both sides of the bridge could announce the company's gift to motorists.

It would be great public relations for the company -- which might bring it more in added sales of its products than the firm spends on the bridge.

Or, better yet, if we are selling the names of our stadiums, why can't we also sell the name of the Bay Bridge? What if AOL or some dotcom company would purchase the bridge for $100 million over the next 20 years?

Think about it: Traffic would flow better with fewer tie-ups and motorists would get to Ocean City faster. People would be happier and more content and might feel obligated to buy the products of the bridge's benefactor -- and kids in the backseat wouldn't have the chance to ask constantly, "When are we going to get there?"

Let's be creative about this and see if we can pull off a William Donald Schaefer and get it done "now" for the beginning of summer 2001.

Raymond D. Bahr, Ellicott City

City teachers need new leadership

The Sun's reporting on the American Federation of Teachers' decision to require a rerun of the elections for the teacher chapter of the Baltimore Teachers Union (BTU) should be quite heartening for the city's hard-working, dedicated teachers ("Rerun ordered in BTU election," Aug. 25).

I am convinced that a new election will once and for all free the teacher unit from the paralyzing grip that union president Loretta Johnson has wielded through a succession of surrogates, including Marietta English, who presides over the union's teacher's chapter.

I served as executive vice president of the BTU teacher chapter under president John Bethea in the late 1970s and early 1980s. Mr. Bethea led the BTU to its reinstatement as official bargaining agent for teachers and the AFT.

In those days, Loretta Johnson, aggressively championing the rights of her paraprofessionals, was motivated by true labor-union instincts. Sad to say, her long incumbency seems to have warped or eroded those instincts severely.

Under Ms. Johnson's leadership, teachers have lost hard-won protections and now serve under several odious and counterproductive management initiatives. For instance, a teacher evaluation procedure -- elaborated over months of negotiation with management -- was bargained away and replaced by a more arbitrary and burdensome portfolio mechanism.

Sharon Blake has led the way in freeing teachers to run their chapter. Ms. English's loss was not merely by a two-vote margin; every vote for candidates other than Ms. Johnson and Ms. English was a vote against those two women.

When and if a rerun is held, it is up to teachers to rally around Sharon Blake and ensure her an indisputable plurality.

The Sun's editorial "Nattering nabobs stifle school reforms" (Aug. 25) was loaded with generalities that fail to reflect the new BTU leadership.

Ms. Blake has brought a fresh sense of professionalism to her office. She has proven she can interact productively with the mayor and the new Board of School Commissioners, as well as with the entire hierarchy of the Baltimore public schools.

Ms. Blake represents the best hope for teachers -- and ultimately, and most importantly, for the students with whose welfare we are entrusted.

Jerry Hammell, Baltimore

The writer is a teacher at Southwestern High School.

Communities can fight trash

Residents tired of waiting for City Hall to remove accumulated trash often overlook a surprisingly effective resource -- themselves and their neighbors ("Weary homeowners yearn for action on city cleanup," Aug. 23).

The first step toward a clean neighborhood is an active community association that makes sanitation a goal. City agencies respond to complaints from organized neighborhoods much faster than to those from individuals.

The second step is for the group to organize and support as many block committees as the area has blocks. A block committee can make the difference between a clean block and a filthy one.

How do you organize a block committee? Invite all block residents to an initial meeting; usually between 5 and 15 residents will attend and these will become the block committee. Pick a block captain or co-captains. Pass the hat at every meeting to raise funds to pay for incidental costs .

And how does the block committee get the block clean?

1. The committee inspects each property on the block, notes every sanitation problem (trash, weeds, rat holes, animal waste, junk, etc.) and starts a file for each problem property.

2. The committee writes to the owner of each problem property, itemizing the problems and asking for their elimination by a certain date. (A property's owner and address can be found by calling Property Location at 410-396-3634.)

3. After the deadline, inspect again. Thank those who cleaned up their property.

4. Call the director of the Neighborhood Services Center to schedule an inspection by a sanitation enforcement officer at a time when one or more block committee members can be present.

5. Show the officer each problem property; if the officer agrees there's a problem, he or she will document the problem with a photo and write a citation that carries a $50 fine.

A $50 citation is usually enough to make the owner clean up. If the problems persist and the property is cited again, the fine is increased.

It sounds simple and it is simple. But a block committee is needed and the committee must keep after chronic offenders.

City Hall can't do everything. It is not equipped or funded to deal with massive trash buildups caused by careless residents and property owners. The only way to deal with these problems is neighbor to neighbor, block by block.

If your neighbor is a slob, get together with your other neighbors who care and force the issue.

City Hall will back you up if you are organized. But if good citizens do nothing, the trashers win.

Grenville B. Whitman, Baltimore

Got a trashy story to tell?

If you know of places in Baltimore where the trash piles higher than the weeds, share it with us. Take a photo, write the address on the back and send it in.

Or send us a letter describing the problem in your neighborhood and how you'd like to see it addressed.

We are looking for 250 words or less; the deadline is Sept. 25. Letters become the property of The Sun, which reserves the right to edit them. By submitting a letter, the author grants The Sun an irrevocable, non-exclusive right and license to use and republish the letter, in whole or in part, in all media and to authorize others to reprint it.

Letters should include your name and address, along with a day and evening telephone number. E-mail us: letters@baltsun.com; write us: Letters to the Editor, The Sun, P.O. Box 1377, Baltimore 21278-0001; fax us: 410-332-6977.

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