Care Reform

Medicare must control wasteful spending As a primary care physician who cares for elderly patients, I read the editorial "Health care reform" (Dec. 26) with interest. The editorial correctly pointed to the obscene discrepancy between the salaries of primary care doctors and specialists as part of the problem in providing cost-effective medical care. But the real question is why specialists earn so much and use up such a disproportionate percentage of our health care resources. Medicare could easily fix the problem by altering its reimbursement policies and limiting visits to specialists, and leaders of Medicare have been talking about doing just that for 20 years.

Public needs media to assist in escape from scandal newsIn a desperate attempt to avoid any more news of the Clinton-Lewinsky affair several months ago, I stopped watching CNN and the network news; scanned the newspaper and skipped any article with "sex," "president," "lies," "intern" or "White House" in its headline; took the talk stations off my car radio settings; and stayed away from anyone involved with the Democratic or Republican parties.When the United States was on the verge of committing armed forces to an assault against Iraq, I was unable to resist my need to keep informed.

With the public clamoring for reform of managed health care, Gov. Parris N. Glendening is making the issue a priority as he begins to articulate his agenda for a second term.Glendening will visit a hospital and senior center today to announce a "Bill of Rights" for Maryland patients. Included will be a half-dozen legislative proposals by which the incumbent Democrat now hopes to put his imprint on the movement for reform."There have been a lot of growing pains for the managed care industry," said Peter S. Hamm, a spokesman for the Glendening campaign.

WILLIAM JEFFERSON CLINTON takes his oath tomorrow as the first Democratic president ever elected to a lame-duck second term. As such, he will be the first intended target of the 22nd amendment passed 46 years ago by Republicans seeking revenge on Franklin D. Roosevelt. The amendment's unintended victims -- Dwight Eisenhower, Richard Nixon and Ronald Reagan -- were Republicans who felt its sting in second terms ranging from lackluster (Eisenhower and Reagan) to disaster (Nixon).How will a Congress controlled by Republicans, who know Mr. Clinton's "four more years" will be his last four years, react to this constitutionally mandated weakness in the presidency?

WASHINGTON -- After years of failed efforts to reform health care insurance, the House soundly approved last night a bill to preserve coverage for people who become seriously ill or change or lose jobs.The 267-151 vote by the Republican-led House represented the most progress Congress has made on the issue in decades."This is a giant step toward health security for all working Americans," said Rep. Nancy L. Johnson, a Connecticut Republican who is among the leading advocates in her party for expanding the availability of health care.

TWO POPULAR BILLS, an overdue increase in the minimum wage and long-sought health care reform, remain in jeopardy because of a brutal fight in Congress largely obscured from public view.Ostensibly, the issue is whether the Republicans can attach "medical savings accounts" to a measure that would guarantee health insurance for workers changing jobs or afflicted with pre-existing medical conditions. But the real contest is over money -- the kind big contributors funnel to political causes.Democrats are furious over large sums J. Patrick Rooney of Golden Rule Insurance Co. has spent to promote a plan that would allow citizens to set up MSAs to get tax breaks in paying medical bills.

HEALTH CARE REFORM is back on the congressional agenda, but political maneuvers by both Republicans and Democrats are likely to kill it.The last time public hopes were raised, President Clinton overreached with a bill so elaborate and controversial it fell of its own weight. This time most Democrats are prepared to support much simpler legislation but conservative Republicans in the House want to load it up fatally. And if they don't murder the measure, some liberal Democrats are willing to do the deed for them.

AGAINST ENORMOUS odds, both houses of Congress have passed measures that take limited but important steps toward health care reform. Unlike the comprehensive proposal put forth by the Clinton administration two years ago, this legislation aspires to modest change.But to Americans afraid to leave a job for fear of losing their health insurance or to those penalized for pre-existing conditions, the reforms championed by a bi-partisan team of Sen. Nancy L. Kassebaum, R-Kans., and Sen. Edward M. Kennedy, D-Mass.

IF YOU doubt that powerful women still drive American men crazy, try to find any men at Hollywood's new hit adaptation of "Little Women." The audiences are large, but, according to the president of Cinema- Score, a national survey outfit, "Males are JTC not showing up to this movie."If a woman is going to be strong, she had better be the sexual predator of undying male fantasies, like Demi Moore in "Disclosure," rather than the intellectually strong Jo March, who has the temerity to reject the hunk next door.

WASHINGTON -- As the Republican-controlled Congress goes on its merry way acting on the GOP's "Contract with America," President Clinton is faced with the reality after two years in office of having to use the presidential veto for the first time.Legislation is on track to limit his conduct of foreign policy regarding U.S. participation in U.N. peacekeeping missions and to remove the requirement that federal anti-crime money approved last year be used to put 100,000 more police on the streets.

If there is any message that has come from this summer's town hall meetings throughout the country, it is that the American public is unhappy with how health care reform is being approached by Congress. As the only physician in the Maryland Senate, I know how legislatures approach health care issues. Politicians are usually tone-deaf to those who know the most about the issue - patients and their health care providers. We all want reform - but not the over-reaching measures promoted in the current bills.

Primary care key to reform The Sun printed two stories this week about shortages of primary care doctors ("The primary need," Commentary, Sept. 27; and "Primary care's hidden loss," Sept. 29). This is a critical issue, and I am proud to have authored a number of measures over the last two Congresses that can help attract more physicians to primary care and ensure that student loan debt is not a barrier to practicing community-based medicine. The Primary Care Training Enhancement Act (H.R.

Deneice Valentine was a wife, mother and college-educated professional with a family income in six figures. But for a year and a half in the late 1990s, she slept in a small park across the street from Morgan State University. Valentine was diagnosed with major depression and a stress disorder but lost her mental health insurance after her divorce. She eventually lost her Baltimore home, custody of her children and the ability to care for herself. Stories like hers are the reason that mental health advocates have joined the immense lobbying effort in Washington on health care reform.

Fifteen years ago, Harry and Louise were the voice of the health care industry opposed to health reform. Today, Harry and Louise have endorsed health care reform, and most of the health care industry is on board. And the pharmaceutical industry is now paying for advertisements promoting health reforms. What gives? Perhaps the industry has a canny ability to negotiate secret deals to protect its interests. We need to know the price we are paying. For example, the pharmaceutical industry appears to have negotiated a secret deal to provide $80 billion in alleged savings over the next 10 years.

With heated debates about reforming health care swirling across the country, professors from the University of Maryland's graduate schools told more than 200 students about how proposed changes might affect their future careers in medicine, dentistry, nursing, law, pharmacy and social work at a panel discussion Thursday night in downtown Baltimore. All the professors agreed that the U.S. health care system needs to be reformed. "We do need to control spiraling costs, but we don't want to do that at the cost of stifling innovation," said Dr. Mandeep R. Mehra, professor and head of cardiology at the University of Maryland School of Medicine.

T.S. Eliot was wrong. August is the cruelest month. As we head toward next month's congressional face-off on a national health care bill, the news media have been infatuated with town hall meetings. Over and over, we have seen angry citizens screaming about a Big Government takeover of the health care system, shouting that they will lose their insurance or be forced to give up their doctors and denouncing "death panels" that will euthanize old people. Of course, none of this is even remotely true.

Camelot, Schmamelot. Despite some of the headlines, what died this week was something that never actually was: The Kennedy Camelot, we now know, was largely myth, created in the wake of a president's assassination and offering a context in which to process so traumatic a national event. But when Ted Kennedy died this week, it was as a man, not a myth. That is the price, or actually the gift, of living to be an old man rather than dying as a young one. What he left behind was something more earthbound than lofty, more practical than poetic.

Our national experience with the Medicare program can provide guidance to the choices our legislators must make regarding health care reform. If one favors more or less government in health care, positive and negative lessons emerge from the nearly 50-year Medicare experience of providing universal health care coverage for all those age 65 and older. Medicare eliminated the fragmented, episodic and often dehumanizing care that many retired seniors were forced to seek through emergency departments or charitable sources because they no longer had coverage from an employer.

Watching the news during the past week became a daily exercise in rubbernecking at the train wreck that was town hall democracy. At a certain point, it beame impossible to determine, and maybe immaterial, who came to meetings congressmen and senators held to discuss health care reform out of genuine concern and who came as part of an orchestrated show of force by one side or the other. Supporters and opponents of the Democratic reform plans said they felt insulted and misunderstood by the other side, and it was clear that little real debate or dialogue was going on. That's what happened Monday night when Sen. Benjamin L. Cardin held a town hall meeting at Towson University.

It's theoretically possible that some of the ordinary citizens who showed up at Monday night's town hall meeting about health care reform with Sen. Benjamin L. Cardin might actually think that the proposals under consideration include government-ordered euthanasia of the elderly. It's hard to believe that they have not seen any of the many concrete debunkings of this myth, and even harder to believe that they would imagine their fellow citizens who represent them in Congress and work in the federal government would be capable of such a thing.