HMOsThe Opinion * Commentary pages frequently provide us...

LETTERS TO THE EDITOR

April 20, 1995

HMOs

The Opinion * Commentary pages frequently provide us with lively observations by local citizens on issues that impinge upon us all.

Whether through personal bias or naivete, the observations of Tim Baker (April 3) present a very slanted version of the role of health maintenance organizations.

He attributes to HMOs the recent decline in costs for employee health benefits, but fails to point out that there were similar decreases in traditional fee-for-service costs including Medicare and Medicaid.

While severe cost problems remain, it was more likely Hillary Clinton scaring the complacency out of the payers and providers, not the advent of HMOs, that caused costs to begin their welcome decline.

Mr. Baker says HMO physicians direct patients to appropriate specialists. All HMOs offer substantial financial incentives to restrict such referrals.

Indeed, Debbie Holloway of Blue Cross and Blue Shield's HMOs stated that they would pay primary physicians' costs to take courses in endoscopy so they might provide their less costly version of these procedures.

Perhaps a short course in cardiac surgery will be their next offering.

Finally, Mr. Baker points out that there has been a migration of workers into HMOs. HMOs are attractive to the young and the healthy who feel immortal.

Traditional fee-for-service plans are favored by those patients with health problems who are willing to pay a higher fee to maintain their existing physician relationships.

The premium costs for fee-for-service plans have risen steadily as healthier patients migrate to HMOs. Once that is complete, HMO costs will rise to equal those of plans with a normal balance of healthy and not-so-healthy subscribers.

Based on these misperceptions, Mr. Baker lobbies the public against any-willing-provider laws.

He maintains that if a physician is willing to abide by the regulations and accept the discounted fees of an HMO, this is "a failure to compete on price and quality."

He buys into the position that any-willing-provider laws restrict a consumer's choices. How can that be?

He then accuses physicians of turning to the legislature for relief, (haven't the last 50 years shown us that legislation is the problem and not the solution?) but the relief they seek is only necessitated by the long history of legislation that enabled HMOs to become established and operate under very favorable financial circumstances.

Mr. Baker is characterized by The Sun as a lawyer who has represented doctors, hospitals, an HMO, and health-insurance plans. It is not difficult to determine which of those many hats he wore as he advocated the HMO panacea.

I shudder to think what the editor intended by attaching the mean-spirited Geoffrey Moss illustration.

F. C. Hansen, M.D.

Baltimore

Tesla a Serb

J. D. Considine states that Nikola Tesla was Croatian (March 17). This is a mistake, and the readers should know the facts.

Although born in Similjan, Lika (Croatia), Tesla had Serbian parents. As a matter of fact, his father was a Serbian Orthodox priest. Margaret Cheney in her book, "Tesla, Man Out of Time," clearly states these facts.

Tesla was a genius, an electrical engineer who spoke several languages and had a photographic memory.

His many inventions include alternating current, the power system at Niagara Falls, transformers, pyro-magnetic generators, electrical meters, radio vacuum tube, etc.

He also is the father of the radio and was at odds with Marconi. vTC Please note that Tesla's memorial, as well as his house of birth and his parents' graves, were completely destroyed by Croats in late 1991 or early 1992.

One of Tesla's best friends was Mark Twain.

Tesla died a U.S. citizen in New York in 1943 at the age of 86.

Snezana Bogdanovic Coffey

Charlotte, N.C.

Reefer Madness II

In an April 14 article the writer appears to accept without question the oft-repeated belief that "the marijuana being sold today is a more potent and dangerous descendant of the marijuana that millions of young American's experimented with during the '60s and '70s."

It may or may not be true that marijuana today is generally more potent. I would encourage all writers who are tempted to repeat this mantra from the continuing "drug wars" to try to find a study to back up this statement.

I have tried and have not been able to find any supporting studies. When I've pressed analysts in the Office of National Drug Control Policy for evidence, they have cited "police reports" or speeches by former Drug Enforcement Agency heads.

These are not studies, these are additional sources of the same statement. The fact is that there are many strains of marijuana, and they vary greatly in various characteristics, including potency. This is the case today and always has been.

The irony of the situation is that we should perhaps view it as quite positive if marijuana were found to be generally more potent today than in previous years.

Why? Because the primary physical damage from marijuana is, like tobacco, from its effect on the lungs.

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