Universal Access

A comparison of the primary health care offered to citizens of 10 industrialized nations has found the United States sitting at the bottom.Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health compared the nations on a variety of counts -- from public satisfaction with health care to infant mortality rate -- and found that only the former West Germany did as poorly overall as the United States. The Netherlands, Canada and Sweden ranked at the top.Relying heavily on data from the 1980s, she found that primary health care in the United States was relatively inaccessible, there was widespread public dissatisfaction with the care, services were expensive, babies were born smaller and died more often and adults weremore likely to die from preventable illnesses.

WASHINGTON -- Democratic presidential hopeful Al Gore fleshed out yesterday a $50 billion preschool proposal that would provide education for three-quarters of the nation's 4-year-olds but relies heavily on state governments.Early childhood education is shaping up to be a surprisingly potent issue on the campaign trail, as more and more families have two working parents. GOP front-runner George W. Bush has veered far from Republican orthodoxy with his preschool proposal, which draws on the guidance of the U.S. Department of Education, an agency that Republicans once targeted for abolition.

To health-care reformers in the United States, the Canadian government-financed medical system seems to be just what the doctor ordered.With universal access, low costs, and good results, a Canadian model has been touted as the cure to the American system, which is overpriced, restrictive and produces some of the worst results for an industrialized country.A recent study of six industrialized countries, sponsored by the Harvard Community Health Plan, a Massachusetts health maintenance organization, found that the U.S. ranked last in infant mortality rate, infant immunization and life expectancy.

To control AIDS, funding must be invested in strategies that work: effective prevention efforts, routine testing and universal access to treatment - and not spent on expensive vaccine research that over 20 years has yielded little of promise other than discovering how not to make an AIDS vaccine. The latest round of vaccine trial failures (including a large-scale Merck trial halted when the vaccine turned out to have possibly increased subjects' risk of acquiring HIV) has added to a growing consensus in the scientific community that an AIDS vaccine is a decade or more away, if one can be developed at all. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, recently stated: "We have to leave open the possibility ... that we might never get a vaccine for HIV."

With tighter state rate regulation helping to slice nearly $100 million from Maryland hospital profits, eight Maryland hospitals moved into the red last year. The hospital-by-hospital results were included in an annual report released yesterday by the Health Services Cost Review Commission, which regulates hospital rates in Maryland. The report also noted: The cost of an average hospital stay in Maryland increased 3.74 percent for the fiscal year that ended June 30. Nationally, for the same period, the cost declined 0.77 percent.

Here's another accolade to add to Maryland's No. 1 ranking among the nation's public schools: This week, a respected national survey of publicly funded preschool programs named Maryland one of the top 10 states for quality early child care and pre-kindergarten programs. The report, by the National Institute for Early Education Research at Rutgers University, was based on data from all 50 states as well as information provided by Head Start, the U.S. Census and other sources. Although researchers found that efforts to improve early childhood education nationally had slowed as a result of the recession, state funding and public support for pre-K remained strong in Maryland, and the percentage of children who enter kindergarten with the skills they need to succeed in school continues to increase.

Each year in Maryland, approximately 75,000 women unintentionally become pregnant. Of those pregnancies, about 36,000 end in abortions and 8,000 end in miscarriages. Additionally, many unintended pregnancies lead to premature births, low birthweight babies and poor maternal health outcomes. Almost all of these unintended pregnancies are preventable with modern contraception, which should be readily available for every American. We, as medical students at the Johns Hopkins University School of Medicine, strongly disagree with any employer - religious or otherwise - that would refuse to provide full insurance coverage, including contraception, for its employees.

WASHINGTON -- The Bush administration has come under growing preessure from its own advisers and from four of the most powerful health-care organizations to propose ambitious, potentially expensive changes in the nation's health-care system to protect uninsured people.A report drafted for an advisory panel appointed by the administration recommends expanding Medicaid to cover doctors' services and hospital care for 10 million people below the poverty level with no health insurance.Various health policy experts estimated that the cost to the federal government would be at least $4 billion a year.

An article in yesterday's MBW section incorrectly named the committee that passed a bill to create an affordable housing trust funded by title company escrow interest. The state Senate Economic and Environmental Affairs Committee passed the bill.ANNAPOLIS -- Bits and pieces:Title companies. Having lost the fight in the Senate to hang onto their escrow interest, title companies now are focusing their battle on the House Ways and Means Committee.The bill that passed the Senate Judicial Proceedings Committee last week would require title companies to give the interest they earn on client escrow accounts to a newly created Maryland Affordable Housing Trust.