Term LimitsIn your June 22 editorial ''Politicians as...

LETTERS TO THE EDITOR

July 05, 1994

Term Limits

In your June 22 editorial ''Politicians as Usual'' you fail to refer to the reason for the growth of the term limits movement. The reason? Congressional obstructionism. The Congress has persistently refused to set the wheels in motion for consideration of a constitutional amendment establishing term limits.

I suspect that congressional recalcitrance was a motivating factor in the Supreme Court's action in agreeing to review. I believe, too, that the review will not be confined to a narrow interpretation of the Constitution, as you suggest, but will also consider individual rights.

alph W. Miller

Baltimore

Medical Costs

With 15 years in solo private medical practice, including a day-to-day role in a hospital utilization program, I take strong exception to Dr. Usha Nellore's allegations (letter, June 25).

First, the central issue in our nation's health care crisis is unnecessary expense (or ''care'') -- unnecessary hospitalization, unnecessary surgery, unnecessary endoscopy and catheterization.

This finding is a consensus which the AMA, Congress, the insurance companies and hospital administrators, all acknowledge.

What motive is behind this excessive and unnecessary pattern of practice? Fifteen years of private practice have shown me it's ''the bottom line.'' Dr. Nellore's assertion that only HMO physicians watch the bottom line is not accurate.

Every small business or sole-proprietorship watches the bottom line with the eye of an eagle, or isn't in business long. This is not intended as criticism of my medical colleagues, but rather of the third-party payers that authorize outlandish fees for invasive procedures but virtually nothing for listening to a patient, answering questions and concerns, and doing something simply and safely.

Physicians are coerced into unnecessary and excessive practice patterns by reimbursement schedules. Dr. Nellore failed to mention private practice motives.

Second, not all doctors are equal in their spending. Dr. Nellore wisely does not assert that HMO patients get well less often, or more slowly or die more frequently. Actually, the outcome of HMO care cannot be differentiated from any other care by any other means yet tested.

Dr. Nellore consistently implies that patients get less care (or less skilled care), but a huge and varied mass of hard data contradict her. The organizing principle of HMO (or ''managed'') care is to rid the system of incentives for excess, thereby ridding it of the excess itself.

Yes, HMOs are selective, and many doctors with ''un-managed'' spending patterns of practice are not welcome. This is to be expected.

Third and last: The Any Willing provider Law (AWL) is anti-competitive. How would the Orioles like ''any willing ball player''? Does Johns Hopkins allow ''any willing professor''?

The AWP Law is affirmative action gone berserk. Cost-conscious physicians should have the right to band together and compete head-to-head against their ''un-managed'' colleagues.

Let patient satisfaction and objective medical outcomes be the criteria for evaluation. I say scuttle AWP and let the competition begin. It's the patients who stand to win.

Dan H. McDougal, M.D.

Towson

Feb. 29, 2000

I greatly enjoyed Frank Roylance's essay on Cesare Emiliani's proposal for calendar reform, (''Looking Ahead Six Months to the Year 11,995,'' June 26).

I fear that Professor Emiliani's system makes too much sense ever to be accepted.

Be that as it may, I would point out one small error in Mr. Roylance's excellent article. In our Gregorian calendar, he says, leap years are omitted in centenary years divisible by 400.

In fact, it's the other way round: Only those centenary years which are divisible by 400 are leap years.

Accordingly, there was no leap year in 1700, 1800 or 1900. However, the much-anticipated millenary year 2000 will have a Feb. 29.

I just thought that readers who have plans for that day would like to know that Pope Gregory has not canceled it.

Bill Gavaghan

Arnold

McLean Saga

The front page article in the June 25 issue of The Sun, ''McLean may retire within a week,'' confirms that truth is stranger than fiction. Let's see if we got this right.

Jacqueline McLean, city comptroller, is accused of being a crook and indicted for fraud and misconduct. She is represented by attorneys M. Cristina Gutierrez and Billy Murphy.

Mrs. McLean goes on unpaid leave; however, her salary is held in escrow. She suffers from depression and is hospitalized in Sheppard Pratt, paid for by her employee health benefits, which apparently she retained. Those health benefits have now expired.

A criminal trial is scheduled but delayed because of her mental state. Hearings are held which were marked by wrangling between her lawyers and Baltimore Circuit Judge Elsbeth L. Bothe. Mrs. McLean breaks down and is involuntarily committed as a state mental patient.

Five members of the City Council intercede with the judiciary on Mrs. McLean's behalf, the trial is postponed until September.

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