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The "non-system' of health care in America

Re: Insurer to raise its rates in July, June 8.

The Florida HealthAccess Network is showing us how a "managed care" model of health care reform would work. This new state-sponsored company, designed to keep health care costs down by pooling employees of small businesses into larger groups, is raising rates an average of 12 percent (as much as $100 a month in some instances), citing inadequate taxpayer funding (legislative appropriation) as the reason. Less pay to insurance agents is this company's idea of an innovative cost-cutting measure. This isn't reforming (fundamentally changing) the U.S. health care system. The profit-taking, trickle-down economics approach didn't work for health care in the 1980s, and a second generation version of this idea won't work in the 1990s. When managed care fails, a predictable development is emergence of a People's Health Care Reform Coalition (PHCRC), to directly pressure health care executives, insurance executives and physicians to change. Even though I'm among those who will be pressured, I don't think that's bad. Because my family and I are also among those who are dependent, on the scariest day of our lives, on the U.S. health care non-system.

Richard E. Thompson, M.D., Palm Harbor

In a cynical effort to win support for health care reform from the medical lobby _ doctors, hospitals, and insurance companies _ the Clinton administration is considering taking away the legal rights of consumers who become victims of medical malpractice.

This is like amputating a limb, when all that was needed in the first place was sensible preventive care. More accurately, it's like cutting off the wrong limb, because malpractice litigation is not the problem.

Malpractice insurance premiums make up less than 1 percent of total health care spending. Just one in 10 malpractice victims ever files suit. And most of what is called "defensive medicine" _ ordering excessive tests and procedures _ appears to be a smokescreen to conceal physician self-referrals (to testing labs they own) that the New England Journal of Medicine estimates costs consumers $40-billion a year.

The real problem is not too many lawsuits, but rather too much malpractice. Instead of cutting off our rights, Clinton's health care task force should be looking for ways to improve the quality of care. Performance reviews for doctors, reliable information about negligent practitioners, and prohibition of self-referrals make more sense than the medical lobby's blame-the-victim agenda.

Every concerned consumer should let the president and the first lady know that national health care should mean quality health care for all Americans.

David S. Simon, Consumer Advocate, Florida PIRG,


There is enough blame for the high cost (and counting) of health care to go around the block several times. We can blame inflation, doctors, hospitals, drug manufacturers, malpractice attorneys and for good measure, include the Medicare system because of the paper work it generates. There is, however, one culprit which has been overlooked or been given scant attention. I speak of us, the health care consumers.

Because the visit to the doctor costs only 10 percent of the amount approved by Medicare, or it costs nothing because a private insurer picks up the tab for the 20 percent, how many times have many of us run to the doctor because of a strange muscle twitch, or the lower back pain (which the doctor had previously told us to learn to live with) moved a bit lower?

To the people who are addicted to these frivolous visits, I suggest that they quit cold turkey because the recently passed deficit reduction plan by the House of Representatives will, without a doubt, be amended by the Senate to include reductions in entitlements and it appears that one of the biggest reductions will be in Medicare benefits. This means more money out of our pockets or from the private insurer. We do not have to guess about what the insurer will do to our premiums.

As my contribution to Hillary Clinton's health reform package, I suggest that it include the denial of benefits to the abuser of the system each time a physician reports an abuse. The physician must be permitted to collect his fee in full from the abuser.

I also suggest that the package includes guide lines to determine the validity of all malpractice suits, because all too often awards are reversed on appeal due to the fact that it was presented by a clever attorney to a jury whose sympathies were misplaced.

Joe Guida, New Port Richey

Re: Nurse practitioners fill primary-care gap, June 2.

I was glad to see a flattering article about advanced nurse practitioners.I have had recent personal experience with both an M.D. and a nurse practitioner that I would like to share. A recent visit to a well-respected M.D. for an annual physical lasted less than five minutes. A mumbled inquiry about how I was doing was mentioned on the way out the door.

Then a hand injury sent me to a non-emergency care center. The nurse practitioner thoroughly assessed my hand, had a radiologist read my X-ray, inquired how my injury affected my activities and gave me complete instructions on pain medication and home treatment of my injury. I was given a follow-up appointment and asked to call if I had any difficulties or questions. Not only that, but she asked if I had any other health concerns to discuss.

My experience with the doctor was rushed, insensitive and incomplete. My experience with the nurse practitioner was of very high quality and at much less cost. Guess where I will go next time I have a health problem?

Camille Caldwell Ware, Clearwater

Great train, poor track

Re: First date: Train says yes, track says no, June 3.

As a rail buff, and former railroader, I motored to Lakeland June 1 to capture the X2000 on film. The train is superb and, along with the German ICE and French TGV, a worthy ambassador of superior European passenger rail technology. It's practical employment in Florida, however, is doubtful.

Bill Adair's article notes the Swedish star was "hobbled by track problemsfaulty switchesdozens of road crossings." All, unfortunately, too true.

From September 1984 to February 1986 I was an "on-board service employee" for Amtrak, riding the famed Auto Train between Lorton, Va., and Sanford, Fla. I did about two round trips per week and kept a sort of trip log, recording special events in a comments column. The majority of entries made mention of "very rough trip," "another broken rail," and "frozen switch(s)." The antics of cowboy motorists in five states also fill this section _ often tragically. Southbound on Sept. 4, 1985, for example, at about 8:15 a.m. I noted: "Collision with vehicle at Orange Park, Fla. _ two hour delay." A woman had driven her pickup truck around the crossing gate in this community south of Jacksonville, then stalled on the tracks. With her were her two children, aged 8 and 5. We struck them at a speed of about 35 mph. The woman survived, the children did not. There were far too many similar incidents. Two teenagers raced us one pre-dawn morning just below South of the Border, S.C., to one of the countless country crossings in that area _ and lost. The largest single piece of the wreckage recovered was a headlight from the car.

The present condition of CSX trackage between Tampa-Lakeland-Orlando is not adequate to support high speed passenger rail service. In Europe these trains run on meticulously maintained rails and roadbeds. In Florida, I have not seen a single concrete crosstie, and many of the wooden ones are so rotten not even termites feast on them! I do not believe speedsters like the X2000 can safely and, what is more important in the boardroom _ profitably _ run on the present condition of "conventional tracks," to say nothing of MagLev trains.

Sigmund H. Klaussner, Tampa

Joining the cooperative

Re: For libraries, cooperation pays, editorial, May 3.

You missed the point of our not joining the Pinellas County Library Cooperative. By the city not joining at the beginning it allowed more money to go to build up the small city libraries surrounding us. That is exactly what happened!

I made this point at the very front-end of the issue. Though you believe that Clearwater should have been in the cooperative from the start, it has been a bonus to the other libraries that we did not join. My position has always been that with the development of the surrounding libraries we should consider joining the cooperative because then the impact on our system would not be as great.

I hope the City Commission will support the move to be part of the cooperative. I believe any funds received should be an enhancement of our system and not used to reduce the current level of support for our library system.

Rita Garvey, Mayor, Clearwater

Education saves lives

Re: What you don't know can kill you, by Howard Troxler, June 7.

Thank you! Education about firearms, not just semiautomatic pistols, will save lives.

Ignorance of firearm safety has caused too many deaths among children, teens and adults. Please teach your kids about firearm safety, or teach them to leave the second they see a firearm.

The NRA (oh, now, hush) has an excellent program for school kids, too bad politics gets in the way of kids getting killed. Sorry, isn't it?

Howard, please tell people that other firearms work the same way semiautomatic pistols do, clips can be removed from rifles and shotguns while leaving the firearm loaded and deadly to unknowing kids, grandmothers or bystanders.

Thank you again, you may have saved someone's life today.

William D. Kroll, Clearwater

Re: What you don't know can kill you. I read the following words in the Troxler column of June 7.

"I believe the Second Amendment protects gun ownership."

A "self evident truth" if I ever saw one.

My opinion of the newspaper has room to move in one direction, up. And that moved it.

It really doesn't make a particle of difference what a person "believes," the fact is the Second Amendment does just that, protects as intended.


C. Merrell, Crystal River

Re: What you don't know can kill you.

Howard Troxler's column in the June 7 issue concerning guns and sex was the most sensible article on these issues that I have ever read in your newspaper.

The answer is education _ not only for these subjects but for just about every subject. If people only knew about things and were more understanding, what a glorious world this could be.

Robert L. Simister, Largo

On vacation?

When I picked up the Times on the front lawn June 8 and June 9 I just knew that your senior editors were on vacation. Who in the journalism world with any responsibility would feature Woody Allen and a Japanese marriage on page 1 on successive days?

At first glance I thought that the supermarkets had begun to deliver their tabloids to our neighborhood.

Bob Wheat, Palm Harbor

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