Cost Of Care

In a sign of the difficulties besetting groups of doctors aligned to secure managed care contracts, one area entity has thrown in the towel while another has retrenched after losing business.New American Health, the managed care contracting arm of the North Arundel Health System, is closing, with the loss of about 40 jobs. Doctors Health, of Owings Mills, laid off 52 of its 148 headquarters staff members this week after losing a major contract.Doctors Health is the largest of the so-called equity model physician groups in the area.

THE CHILD-CARE dilemma is often written off as a problem for working parents, which lets everyone else off the hook. But as any first-grade teacher can testify, the quality of care in the pre-school years makes a huge difference in a child's prospects for success in school. For that reason alone, the issue is worth the attention of the presidential bully pulpit.But as important as it was that President and Mrs. Clinton convened a White House conference on child care last week, we'll know we are really making progress when school superintendents or even university presidents convene such gatherings to highlight the fact that these early years are crucial learning years -- and that the academic training of child care workers is as important as the training of any other teacher.

ANYONE WHO has cared for a terminally ill patient or even visited a nursing home knows that the process of dying is rarely cost-effective.And anyone familiar with the market pressures changing the landscape of American health care knows that cost-effectiveness now drives more medical decisions than we like to admit.Therein lies one of the dilemmas of physician-assisted suicide -- one not touched on in two recent decisions from federal appellate courts overturning long-standing bans on the practice.

IN MY EARLY days as a medical doctor human life was preserved whatever the cost. The mantle of "physician," entrusted by Hippocrates, was worn with pride and a sense of responsibility. Saving lives was the very wellspring of doctoring. Why else would someone suffer the rigors of medical school and the grueling hours of post-graduate training? Why else would anyone leave his bed at midnight to meet the tedious task of attending the helpless and hopeless? In the early 1960s, the high calling of medicine meant that human life was worth any price.

For the 700,000 Marylanders who lack health insurance, somebody else ends up footing the bill. Last year, hospitals were left with $400 million in uncompensated care.A large share of that bill falls on inner-city hospitals in Baltimore City where many uninsured patients live. Then a vicious cycle begins, in which these city hospitals have to raise their rates to counteract their financial losses on charity care, while hospitals elsewhere are able to keep charges comparatively low and draw more patients whose insurance can pay the bills.

As Maryland's General Assembly grinds toward adjournment, the issue likely to dominate the last two weeks of the 90-day session has finally burst into full bloom like so many daffodils in spring.That issue, of course, is money.Bill after bill pending in the session's final days has to do with money: Someone has it, and someone else is trying to change Maryland law to get it.Health maintenance organizations (HMOs) and insurers have it, but doctors are demanding a piece of the action. Local governments have it, but long-distance telephone companies want a tax break to get some of it back.

Medical technology and American doctors' willingness to use it aggressively gave Chardae Henry, born weighing less than 2 pounds, her bumpy entry into the world.It gave back to John Rigione, 74, his breath and strength, by opening the clogged arteries around his heart.It gave Faye Godfrey, 47, a better picture of the torment inside her back and the hope that it might be healed, and she got that picture painlessly and with no wait.But as the United States ponders how to reshape its health system, the staggering cost of the kind of intensive treatment afforded these diverse patients is coming under new scrutiny.

With momentum for health reform building, Maryland hospitals are squaring off against managed-care companies in a struggle that will determine how health care is delivered in the state.The looming battle is an outgrowth of marketplace pressures that began mounting as a result of spiraling health care costs and anticipation of the Clinton administration's health care reform plan, unveiled last month.Arrayed on one side are those favoring an incremental evolution of the hospital regulatory system.

The state agency that regulates hospitals will allow Blue Cross and Blue Shield of Maryland to keep a discount worth nearly $20 million pending a public hearing in September.The Maryland Health Services Cost Review Commission yesterday agreed to take a second look at the 4 percent discount on hospital costs granted insurers that provide coverage to all comers during open enrollment periods.The hearing will determine whether the benefits provided to people turned away by other companies because of their medical conditions justify the millions of dollars in discounts to the Blues and a few other companies known as insurers of last resort.

Chevy Chase. -- Almost every day since Harris Wofford used the health-care issue to win an upset Senate race, headlines have breathlessly portrayed broad reform of the current system as just around the corner. Cooler heads say this won't happen soon because polls show most middle-class voters remain satisfied with the care they receive from their employment-based group health insurance.Some companies, however, are taking a radical step to rein in skyrocketing health costs. If the move takes hold -- and two federal appeals courts recently gave employers a green light -- it FTC may not be long before voter satisfaction turns to the outrage necessary for fundamental change.

For centuries, doctors were in charge of health care decisions for their patients. During the last couple of decades, doctors have been driven out of the decision-making process. Health care decisions are made by administrators (substitute "bureaucrats" in the future) employed by insurance companies to keep costs down. To make matters even worse, doctors live in fear of lawsuits and ever-increasing malpractice premiums and sometimes order unnecessary tests and procedures just to cover their rear ends.

We've been hearing a lot about universal health care. But before you give up on market competition, consider that government regulation of hospitals and medical professionals makes medical care much more expensive than it need be. We seldom hear about difficulties in finding a doctor, rationing of services and poor-quality care under universal health care schemes - even though such problems are already happening in government-run programs in California....

In an ominous sign for drug makers, the number of prescriptions dispensed by pharmacies in the United States is growing at its lowest rate in at least a decade as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs. The pharmaceutical industry by conventional wisdom is resistant to economic downturns, because people need medicine in good times and bad. But data from market researcher IMS Health and Wall Street analysts indicate that the rate of prescription growth has fallen steadily since early last year and in recent months has slipped in and out of negative territory.

It's not a sexy issue such as gay marriage or illegal immigration, yet the importance of what we do - or don't do - regarding the health and housing needs of our seniors may have more economic, physical and moral relevance for families than any other problem before us. Let's face it, Americans simply don't plan for old age - either individually or as a society. We focus on youth; envy and sex lurk behind our every advertised need. The media, with their focus on the scandalous and the sweet, don't help much.

For all the work Christopher Reed has done as vice president of fundamental research for Harris Investment Management Inc. in Chicago, he still can't figure out whether he should buy long-term-care insurance for his parents. "There are so many variables in long-term care and so many issues - health, taxes, estate planning," he said. "Then you get presented with a policy and your eyes glaze over." Long-term-care policies are designed to help pay for all sorts of expenses people can incur as they age. These range from such simple things as home help in performing everyday tasks that are taken for granted, such as bathing and eating, to the cost of a nursing home, hospice or assisted-living facility.

Health insurance for all I recently admitted an 8-month-old boy to the hospital for failure to thrive and developmental delay. Failure to thrive is an alarming diagnosis in an infant - at a time when he should have been growing and developing, this child was losing weight and not reaching new milestones or gaining new skills. His insurance company approved his admission - for one day. One day. One day to put weight on and turn his development around. This is what our health care system has come to - reducing costs by denying care, shortening hospital stays and transferring the ever-increasing cost of care to patients and their families.

Members of the Maryland Association of Certified Public Accountants are answering readers' tax questions through April 15. See below for how tosubmit a question. Is a child care tax deduction available for toddlers enrolled in pre-K3, pre-K4 and kindergarten if you have to pay to send them to classes? Yes. But the IRS makes a distinction between the cost of "care" and the cost of "schooling." Normally, only the cost of care can count toward the credit. But if your child is in a grae below first grade, and the amount you pay for "schooling" is incidental to and cannot be separated from the cost of "care," you can count the total cost of sending you child to preschool.

In a sign of the difficulties besetting groups of doctors aligned to secure managed care contracts, one area entity has thrown in the towel while another has retrenched after losing business.New American Health, the managed care contracting arm of the North Arundel Health System, is closing, with the loss of about 40 jobs. Doctors Health, of Owings Mills, laid off 52 of its 148 headquarters staff members this week after losing a major contract.Doctors Health is the largest of the so-called equity model physician groups in the area.

THE CHILD-CARE dilemma is often written off as a problem for working parents, which lets everyone else off the hook. But as any first-grade teacher can testify, the quality of care in the pre-school years makes a huge difference in a child's prospects for success in school. For that reason alone, the issue is worth the attention of the presidential bully pulpit.But as important as it was that President and Mrs. Clinton convened a White House conference on child care last week, we'll know we are really making progress when school superintendents or even university presidents convene such gatherings to highlight the fact that these early years are crucial learning years -- and that the academic training of child care workers is as important as the training of any other teacher.

ANYONE WHO has cared for a terminally ill patient or even visited a nursing home knows that the process of dying is rarely cost-effective.And anyone familiar with the market pressures changing the landscape of American health care knows that cost-effectiveness now drives more medical decisions than we like to admit.Therein lies one of the dilemmas of physician-assisted suicide -- one not touched on in two recent decisions from federal appellate courts overturning long-standing bans on the practice.