Share the RiskThe crisis in health care continues to grow...


October 29, 1992

Share the Risk

The crisis in health care continues to grow. To exacerbate the problem, some existing Maryland health maintenance organizations and some new ones coming into our state are offering lower rates to potential business subscribers whose census reflects lower than average risks. The end result will be that these lower risk groups will be skimmed off by the lower price offering, leaving the higher risk groups with the Maryland Blue Cross and Blue Shield.

A small employer who has one employee with a major illness is denied the ability to change carriers for a lower rate since no new carrier will accept his group. Increasing rates to these small groups are becoming prohibitive, and the consequence will be more uninsured.

Although I have little sympathy for the Blues in the light of recent revelations, the Blues are being adversely affected by this process.

Soon, those covered by the Blues will not be able to afford the premiums in these remaining groups, which will contain a disproportionate number of the chronically ill.

A fairer method would be, if the market is to remain open, to force all HMO's to share the poor risk groups.

Another alternative would be to let employers assign the chronically ill to a special group that would be underwritten by all the insurance premiums in the state, similar to the old Assigned Risk Automobile Insurance program.

Gerald Jeffein


A Board for Paramedics

It is fairly obvious that the area of Emergency Medical Services (EMS) in the state of Maryland is going through many changes. Philosophical paradigms throughout the political structure of Maryland EMS have crippled the progress of EMS as a profession, in comparison to major EMS systems in other parts of the country.

One vital example was discussed in an Oct. 11 article, "What the rescue crew can't do to save you," where endotracheal intubation, considered to be a "gold standard" technique for paramedics, is prohibited from being used in a few jurisdictions, even though some of the personnel are nationally registered to perform this technique.

Dr. Kimball Maull, the newly appointed director of the Maryland Institute of Emergency Medical Services Systems, when asked about this problem in the article replied: "My reaction is embarrassment."

Currently Nationally Registered Emergency Medical Technician-Paramedics (NREMT-Ps) are certified to function in Maryland as a delegation of duties by a licensed physician.

When EMS was in its infancy this structure of physician-delegated practice was formed as a matter of necessity to guide the initial direction of pre-hospital EMS. With the birth of baccalaureate and graduate studies in emergency health, as well as a field that is greater than 25 years old, I feel review of the legislation regarding paramedic certification is due.

A paramedic is recognized by the American Medical Association as a medical professional. In Maryland, a paramedic functioning as a physician designee is not a recognized medical professional in the same league as nurses, respiratory therapists and pharmacists.

The Department of Health and Mental Hygiene utilizes boards of peers to license members of certain professions.

For example, there is the Board of Nursing and Board of Pharmacy. There even exists a Board of Barbers, a Board of Cosmetology and Board of Funeral Directors. Currently there is no similar board for paramedics.

Perhaps the Governor's Task Force on Emergency Medical Services can examine the issue of creating a "board of emergency medical technician-paramedics," whose function would be to license paramedics in Maryland.

This would elevate the professional status of the paramedics to the same level as other AMA-recognized health professions. I believe that the benefit derived from this would translate into improved care, new techniques, and increase the impact that we pTC have on saving lives.

Gregg S. MacDonald


Good Coverage

I would like to commend The Sun for your excellent coverage of the abortion referendum in the Perspective section (Oct. 18).

The parallel question and answer columns were quite informative, but what I really appreciated was your printing the entire text of the law itself.

I get so tired of lobbyists telling me what something says. I like to read it for myself to see what it really says. Then I can evaluate what the lobbyists are saying about it. (After reading the law, I thought the Vote kNOw answers to your questions were generally more honest.)

To the best of my recollection, this is the most in-depth presentation of the abortion issue The Sun has published.

Beyond the stream of immediate news, such as marches, court decisions, laws, quotes from activists and editorials, I have been quite disappointed by the news media's poor coverage of the underlying issues over the past 20 years.

I have never seen the text of Roe vs. Wade published, yet it is clearly one of the most controversial documents of the Twentieth Century.

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