December 28, 2008

Universal health care is the real solution

The Baltimore Sun's three-part series "In Their Debt" (Dec. 21-Dec. 23) was more compelling when it pointed to the failings of the current health care financing model than when it questioned the efficacy of Maryland's unique "all-payer" hospital rate-setting model.

While we spend far more than any other country on health care, about 46 million people in this country (including 800,000 in Maryland) have no health insurance and millions more have inadequate insurance. That's what leads to the tragedies recounted in the series.

Until we guarantee health coverage for all, we must praise Maryland's hospital rate-setting process. It generally works well for the 6,000 Baltimoreans and 12,000 Marylanders who were served by Health Care for the Homeless last year, about 70 percent of whom were uninsured.

We couldn't do our work without the care provided by Maryland's hospitals, as we are so often reminded by our less-fortunate colleagues in states that have a different model.

To be sure, Maryland's "all-payer" model both mitigates the failures of the broader health care system and reflects some of that system's shortcomings.

But let's not throw out an ameliorative measure that works until we've implemented an effective alternative, or direct the frustration generated by this series at the overwhelmed actors holding together a broken system.

Instead, let's build a national model of universal health insurance; this will provide the financial security needed by hospitals, health centers and the people we serve.

Jeff Singer Kevin Lindamood, Baltimore

The writers are, respectively, the president and CEO and a vice president for Health Care for the Homeless.

Pure business model wrong basis for care

The Baltimore Sun's series on the billing and collection practices of hospitals should make people ask if health care is a business or a profession ("In Their Debt," Dec. 21-23).

Health care-related businesses function on a transactional business model. In this model, patients have to pay what is charged or they will not get the services they need. But physicians have typically worked on a relational business model, one in which medical services are provided as part of a long-term relationship between the physician and patient.

In a relational business model, there are moral and professional entanglements between the professional and the patient in addition to the business relationship.

If we allow hospitals to function just like any other business, the kinds of reports cited in the series shouldn't surprise anyone.

But only by maintaining professionalism in medicine, and treating health care as a community resource, can we maintain the human aspect of care that is so important to everyone involved.

Dr. Tyler Cymet, Baltimore

The writer is president of the Baltimore City Medical Society Foundation.

Would club members endorse smaller offer?

Putting aside, for the sake of argument, the huge and, in my opinion, insurmountable issue of rezoning the land involved, if the scenario proposed in the editorial "Tie-breaker?" (Dec. 15) plays out and the Keswick Multi-Care Center designs a new proposed facility that is "smaller and greener," I wonder if the company would also reduce its offer for the Baltimore Country Club's land.

If it does do, and club members are allowed to make a choice without the threat of increased assessments if they don't approve the deal (a threat they faced in voting on the first Keswick proposal), would members vote again for the Keswick development or, if given a comparable offer from the community, vote for the community's greener, more sustainable - dare I say Smart Growth - proposal?

I believe that they would vote for the latter alternative.

Martha Marani, Baltimore

The writer is a board member of the Roland Park Community Foundation.

Send alleged swindler right to Guantanamo

I think Bernard L. Madoff, the alleged swindler, should be locked up at Guantanamo Bay ("The richest con," editorial, Dec. 20).

What's that, you say? "He hasn't been convicted of anything"? Right. Then Guantanamo is the right place for him. None of the other inmates there has been convicted yet either.

It's perfect.

Harry Leffman, Baltimore

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