No AltruistsYour April 1 editorial and subsequent column...


April 10, 1994

No Altruists

Your April 1 editorial and subsequent column by Barry Rascovar portrayed non-HMO physicians as greedy money-grabbers. HMO managers and physicians presumably are splendid fellows, altruists.

This year's "any willing provider" bill before the legislature would give the HMO enrollees the option to choose their own doctors. Rather than doom HMOs, as the HMO industry and its supporters claim, this bill would keep HMOs competitive in terms of enrollee service and enrollee health care.

If an HMO gives good service and its doctors provide good care, its enrollees would not be inclined to pay money out of their own pockets to obtain care outside the HMO.

On the other hand, if an HMO gatekeeper is more concerned with the HMO's bottom line than with a patient's needs, the enrollee can go elsewhere without losing completely the value of what he has paid the HMO.

A health maintenance organization is a business. It needs to have a large enough number of enrollees to be profitable. It gets that number by serving its membership well enough to keep most of its enrollees and recruits new enrollees to replace those who leave.

It is good for profits if the sicker enrollees -- who are the most expensive to serve -- leave and are replaced by new, likely healthier people.

With such considerations in mind a gatekeeper might tend to delay and skimp on service to a seriously ill enrollee with the expectation that that enrollee will either accept the poor service or, if he can, move his enrollment to another HMO.

Joan and James Childress


Happy Smoker

The class action suit against the tobacco companies is an insult to anyone who smokes and anyone who died of an illness labeled as "smoking related." Do these people think smokers are idiots and have no understanding of the risks?

Personally I would rather risk dying young of one of the many diseases associated with smoking than spend one day in a nursing home. I think our founding fathers called this freedom to choose.

I know many people who have quit smoking and gone back to it. By the same token, I know many people who have gone on a diet and lost many pounds, only to gain them all back. I have known alcoholics who have quit drinking, only to go back.

Addiction is nothing more than a state of mind. When your mind is made up to change your behavior, there is usually a high success rate.

Some people fight the urge to smoke, others the urge to do drugs or alcohol and others the urge to eat. Some make it, others do not.

The most important point is that there has to be a personal desire to quit doing anything that our government has determined to be "risky behavior." It is a personal choice, and it appears that there are too many people who want to make these choices for all Americans.

In my opinion, the only thing that is going to be accomplished by the constant attacks on the tobacco industry through taxes and law suits is another black market.

To all the intolerant non-smokers, God bless you. May you live a long and healthy life and some day wake up and realize this is America, not some Third World communist country.

Tobacco has been around for thousands of years and is not going to disappear because you don't like it. But if you have your way it will probably put the final nail in the coffin of our economy.

Jean Walker


Grandma Knew

My grandmother was fond of quoting:

"We little know what a web we weave, when first we practice to deceive."

1% It certainly applies in Arkansas.

Alexander K. Barton

Sherwood Forest

Education: More than Money

In her March 27 column, Sara Engram states "in education money matters." Of course it does.

If it did not matter, would Montgomery Countians spend as much as it does to educate its children?

For all the reasons discussed by the Governor's Commission on School Funding, and all the reasons it did not have time to discuss, money does indeed matter in education.

Maryland has a constitutional obligation to provide thorough and efficient schools. It is past time for the state to get its spending priorities straight and "adequately" fund those schools.

The problem with Ms. Engram's column, however, is that it presents a one-sided view.

The governor's commission found that school funding was not the only barrier to learning, and its report included recommendations to address this finding.

It is disturbing that these recommendations received virtually no attention. The commission's report was simply reduced to the issue of should we or should we not increase school funding.

Montgomery County spends more to educate students than any other school district; yet its impoverished students perform LTC poorly on state tests. Factors other than school funding are preventing these students from learning, and those factors must be addressed.

Wealthy, educated and politically empowered parents will always obtain the education they want for their children.

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