Can reforms curb cost of Medicare?

The Baltimore Sun

The Medicare system is far more expensive than it should be, but with some simple tinkering, its inefficient backbone could easily be repaired ("Fixing Medicare," editorial, July 28).

Under Medicare's current reimbursement policies, high-cost tests and procedures are well-reimbursed while preventive care is not. Yet study after study has demonstrated that primary care medicine emphasizing prevention is more cost-effective and leads to better health outcomes than our present procedure- and specialist-oriented medical system.

In Maryland, specialist doctors earn an average of three times the salary that primary care physicians earn. No wonder so few medical students enter primary care fields.

However, no one has attempted to change the existing dynamics.

The solution is simple. Medical care reimbursement is not determined by the free market or by any other rational process but by what Medicare pays each doctor for what he or she does. If Medicare altered its reimbursement system by rewarding preventive care and giving a smaller financial incentive to tests and procedures, not only would the cost of health care drop without any decline in quality but the altered financial incentives might prompt more medical students to pursue primary care fields.

Dr. Andy Lazris, Ellicott City

The editorial regarding ways to fix Medicare suggests that billions of dollars worth of excess tests ordered by doctors could be trimmed by focusing on preventive treatments rather than on paying for each test and treatment ordered.

Although that concept makes sense, the fact is that it would not work well at all.

As long as physicians are held hostage by an overly aggressive and punitive legal system in which they can be punished for not doing "everything" (even when it makes no sense), there will not be real cost containment.

Under such a system, excess blood tests, EKGs, X-rays, CT scans, MRIs, etc., will be ordered with increasing frequency, no matter what else happens.

Don't believe me? Don't ask the Maryland Bar Association or some academic sitting in a university office. Ask your own doctor; ask your local emergency room physician; ask someone who is in the trenches like I am.

Do I think that the system will change? Nope.

Do I think that costs will continue to spiral out of control?

Sadly, yes.

Dr. Edmund J. MacLaughlin, Cambridge

Low-wage workers need income credit

The minimum wage debated in "Wage Rage" (Commentary, July 25) is a subsistence-level wage that often forces a breadwinner to choose between heat and groceries. Indeed, two or three minimum-wage jobs are frequently not enough to make ends meet.

Yet some conservative commentators insist that this meager level of compensation is going to cause many small businesses to close their doors.

Meanwhile, some corporate CEOs, professional athletes and entertainers make hundreds of times what the average U.S. worker takes home.

This is simply how the free market works - and the haves and the have-mores are fabulously wealthy because they deserve to be paid more, the conservative economists say.

What is often left out of this debate is the idea of an earned income tax credit, a supplement that could bring subsistence-level wages up over the poverty level.

If a business cannot or will not pay a worker a fair wage, an earned income tax credit should kick in to enable that worker to raise a family with economic security, purchase a modest home and have access to decent health care.

This would pose no danger to the free market at all, and it would only be fair.

Lee Lears, Annapolis

Mock disasters don't help prepare

I read with interest the article "U.S. trims state's funding" (July 26).

I think more federally funded disaster simulation exercises or grants for things such as a one-day simulated "catastrophic event" at M&T; Bank Stadium just don't cut it.

Planned disaster simulation exercises with 100 or 200 people sitting in a stadium tagged with simulated injuries in an orderly fashion just do not reflect a real-life disaster.

A better use of limited federal disaster funds would be to provide more funding to meet the day-to-day operational needs of our emergency and public health agencies.

Dick Johnson, Catonsville

The writer is the founder of the Golden Hour Coalition Inc., a nonprofit watchdog group for the state's emergency response systems.

Spying abridges right to assemble

The comments by the writer of the letter "Police must spy to keep us safe" (July 26) are naive.

The Constitution guarantees the right of peaceful assembly to citizens.

Government spying on such assemblies simply because of the political beliefs of those assembled abridges that right.

Thomas G. Pinter, Lutherville

Use paper ballots if lines get long

In November, many Maryland voters will once again experience extremely long waits on Election Day ("Predicting long delays at polls, group urges paper ballots in Nov.," July 24).

This happens because voters don't appear at the polls evenly throughout the day. Many people are able to vote only before or after work, so urban precincts often have long lines in the early morning and, especially, in the evening.

The result: Across the state, thousands of people will be denied their right to vote because of the long waits they face. This situation is made worse because every voter in Maryland, except the absentee voters, must use a touch-screen voting machine.

Because they are so expensive, there are only a limited number of voting machines - typically 10 to 12 for each precinct. With 10 machines typically able to serve only about 60 voters an hour, just put 60 voters on line and you've got a one-hour line.

The solution: Whenever the number of people waiting to vote causes the wait-time to exceed 30 minutes, use the emergency paper ballots with which every precinct is already supplied.

These are the same ballots that thousand of voters currently use for absentee voting.

If machine failure justifies using paper ballots - as it currently does - then long lines that disenfranchise voters should also justify using those ballots.

Michael Berla, Columbia

Smaller arena is a better fit

Before we go diving into building a huge facility downtown, let's think rationally ("Planners see arena reviving west side," July 26). In the current economic climate, a small arena would best suit the needs of the city.

Let's be realistic: This city does not currently have the fan base or financial ability to support pro indoor franchises such as the NBA or NHL.

So let's build a small arena now, and if an NBA or NHL franchise finds Baltimore an attractive market in 10 or 15 years when the city may have a more viable shot at supporting such a team, then construct a larger arena.

Baltimore will not obtain a new professional team just because we have a professional-style venue. For proof of this, just look at Tampa Bay's experience with Tropicana Field.

After Tampa built the stadium in the late 1980s, it sat underutilized for nearly 10 years. By the time the Devil Rays started calling the Trop their home, the stadium was essentially obsolete.

Since then, about $100 million worth of renovations have been made in an ongoing attempt to modernize the facility (the original building cost about $145 million). And after all of that, the Rays are now trying to get a new $450 million facility.

Certainly, Baltimore and Tampa's situations are not exactly parallel. But the underlying themes remain the same: If you build it, they won't necessarily come.

A new arena will cost a lot of money, and we ought to be smart about how that money is spent.

Kevin Kristofco, Baltimore

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