The Palm Beach Post from West Palm Beach, Florida on March 31, 1998 · Page 17
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March 31, 1998

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The Palm Beach Post from West Palm Beach, Florida · Page 17

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West Palm Beach, Florida
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Tuesday, March 31, 1998
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nm I'n THE PALM BEACH POST TUESDAY, MARCH 31, 1998 17A- Managed care' becoming a frightening oxymoron Too bad they don't have an Oscar for the Single Best Line in a movie. A Zeitgeist award for the sentence you want to Vie backlash is driven by horror stories of plans that won't pay for emergency care, by cancer referrals denied, by stories about a mother, neighbor, friend. tfreeze-frame, the magical moment when Hollywood fantasy meets daily life, when they get it absolutely right. Ellen Goodman search to show how often health care is refused, or how often the hassles and hurdles have lethal consequences. The backlash is driven by horror stories of health-care plans that won't pay for emergency care, by anecdotes of cancer referrals denied or delayed, by firsthand stories about a mother, sister, neighbor, friend. We have gotten the big picture as well. About 15 percent of the population accounts for 80 percent of the medical bills. In the phrase Mr. Glasser used in the March issue of Harper's, HMOs are "a Ponzi scheme" in which the premiums have to keep ahead of claims. But the backlash scenario presents the HMOs with a dilemma. On the one hand, employers and employees may choose a system based on how it treats the very ill. On the other hand, HMOs want to enroll the very healthy. In general, managed-care companies have shown the public relations skills of Ken Starr. In the past year or so, we've had massive reports of outpatient breast surgery and drive-through deliveries. All we've seen in return is HMO companies as corporate demons. Indeed if you watch Tlie Rainmaker, the HMOs are taking the place of the Russkies as the bad guys. As Ronald Glasser, a Minneapolis pediatrician, HMO critic and moviegoer who was downing popcorn when the audience roared at Ms. Hunt, exclaims, "I looked- around and said, 'My God, the people are way ahead of the politicians on this.' " A few years ago, the public saw doctors as rich professionals who overcharged on Tuesday and played golf on Wednesday. The system weaknesswas cost control, or cost out-of-control. Now doctors and consumers are becoming allies, fighting the HMOs, hassling the 800 numbers, trapped in a medical system we suspect is being run by accountants. The weakness in the system is trust. Or rather, mistrust. It is an astonishingly swift transformation. Bob Blendon who polls healthcare issues at Harvard School of Public Health is about to publish a study of the consumer backlash which confirms Helen Hunt's less professorial opinion. His survey of surveys proves, "We Now politicians who read the papers and go to the movies, are playing catchup. There have been about 1,000 bills filed in state legislatures to protect the consumers from the managers. In Washington, the Congress is still dithering around with various forms of a Patient's Bill of Rights, with Republican leadership trying to stall, duck and weave. But it is getting pushed closer to a law that would provide for an external appeal to those denied care, access to emergency room, and an ombudsman program. . As for the HMOs? Those folks who brought us Harry and Louise, are now warning us about Frankenstein. The latest ads say, "Washington: Be careful how you play doctor, you might mandate a monster." - A monster? It's the unmandated, Unregulated system that has now produced the horror movie running in everybody's head. Any way you look at health care, even in a darkened theater, this is not as good as it gets. Ellen Goodman is a columnist for The Boston Globe. -1 Helen Hunt and Jack Nicholson picked up Oscars last week for Best Ac-I tress and Best Actor for their starring roles in As Good as It Gets. But the Best Line prize goes to the scribbler who put these ungenteel words in Ms. Hunt's mouth. When the distraught mother gave her opinion about the managed I medical attention being given her asth-i matic son, she exploded: "F HMO B- Pieces of S-!" I At this outburst with none of the j expletives deleted audiences all over America spontaneously burst into ap-Jplause. It was one of those moments J when you know the tide has turned. J HMOs have become the new exple-tive undeleted. Managed-care com-Spanies are rapidly replacing tobacco have changed the whole politics of the health field. Essentially patients and doctors have come together in a new class of exploited people." On the one hand, polls show that most Americans are satisfied with their own health-care plans. On the other hand, they favor some type of government regulation. These two views seem contradictory, but the backlash is based on the widespread anxiety about what happens if they get sick. "People have come to believe," says Mr. Blendon, "that these plans won't do the right thing for them when they are very sick." There isn't yet much objective re No clarity, just more advocacy Opening Day begets thoughts of the cosmos -Our demand for instant analysis, and quick and painless answers, , 'seems inevitable. But ..-for the survivors, in "Jonesboro as well as 'rthe nation, pat answers .....and spin must be ' viewed as part of a ' much bigger picture. .By Peter Applebome Almost from the moment the . bullets stopped flying outside West- side Middle School in Jonesboro, .Ark., the explanations and analysis By Bill Tammeus As another season of big-league baseball opens, it's my duty as member No. 533 of the Emil Verban Memorial Society (oh, I am too) to explain again why baseball is so crucial to our body politic and why much of what you think you know about baseball simply ain't so. (I say "again" because some of you weren't listening the first several dozen times I've waxexl eloquent about this.) ! . Every time I drop Emil Verban's name into a casual conversation, I'm stunned to learn some people have never heard of him. If you are among the unenlightened, please know that Emil was the second baseman for the Chicago Cubs in 1948, '49 and '50. And in his total 7-year big league career, he had 2,91 1 at-bats and hit one (that would be, uh , 1) homer. My Verban Society colleague, columnist George Will, once claimed Mr. Verban's record demonstrated mediocrity under pressure. But! I don't share Mr. Will's dismissive view of Mr. Verban's workmanlike career, which had several highlights. ; For instance, Mr. Verban also known 'as "Dutch" and "The Antelope" played in the 194 all-St. Louis World Series for the Cardinals against the Browns. And he batted .412 in that series, going 7 for 17 and driving in two runs. Beyond that, his team became world champs. Also, he played on the National League's 1946 All-Star team. What, I ask, began whizzing by. It was guns. It was the violent ;; culture of the South. It was the vio -VSj f I i i Jilt r.i 5'.'... ' ;'V' J " ' ' '", ' . v it i , lent culture of American media. It 7 was bad parenting. It was the I breakdown of the family caused by liberal politics or economic stress. It was violence against women. It was " lax juvenile justice laws. There was much that was true "and valid in the instantaneous grooving for meaning that followed the horrendous shooting incident in which two young boys are accused of killing four girls and one teacher, and wounding 10 others. But to many students of American culture, there can be something sadly di-Tminished, and ultimately misleading, in the ritualized rush to instant judgment or the rush to instant spin and advocacy that now follows each cataclysmic lurch of the news cycle. And it is worth asking whether THE ASSOCIATED PRESS A billboard outside Jonesboro, Ark., reminds all who enter the town of a day spun out of control. is mediocre about that? Well, you see what's happening here? You start out in baseball with one subject and before long you've digressed into a digression of a digression. But that's one of the beauties of baseball. You have ; the babble of interpreters provides insight or just sows more contusion and cynicism. "Not only in the media but in the "so-called helping services the ity for raising kids rests with parents, not governments. It is a reminder how much of what passes for analysis is really little more than advocacy. "Instead of just going there and yanking on the heartstrings, we've now got armies of pundits ready to hold forth on a moment's notice with various simplistic notions of what just went down," said Mark Crispin Miller, who teaches courses on the media at New York University. "We don't use the word 'propaganda' much anymore, but the constant heavy drone of knowing voices out there is largely a chorus of propagandists talking at us." Others say that in the rush to judgment, it's not just the answers that fall short, it's also the questions. June Jordan, a professor of African-American studies at the University of California at Berkeley, notes that the overall frame for the coverage in Jonesboro How could it happen in a nice small town like this? differs sharply from similar inner-city tragedies, where the context is often the inherent depravity of the urban environment and its "So much of what we hear through the media, comes through such a racialized prism," Professor Jordan said. In a society addicted to fast food, e-mail and ever-faster computer chips, a demand for instant analysis seems inevitable, even logical. The real question is whether that coexists with a more questioning scrutiny that realizes the pat answers and spin are only part of a much bigger picture. George Steiner, the literary critic and classicist, is one who is doubtful. "I think the sound-bite mentality cheapens thought," he said. "Imagine Dostoyevsky. There are some incidents like this, two boys killing other children, in his famous diary. Imagine what Dostoyevsky would do with that. He would deal with the transcendentally important question of evil in the child. Today the editor would say 'Fyodor, tomorrow, please, your piece. Don't tell me you need 10 months for thinking. Fyodor, tomorrow.' " Peter Applebome is a reporter for The New York Tunes. trinsic need for coherence and meaning in the face of unfathomable events. In his book News Values (University of Chicago Press, 1996), Jack Fuller, the former publisher of The Chicago Tribune who is president of the Tribune Publishing Co., argues that at a time of information overload, making sense of events, rather than just reporting them, is an increasingly critical part of the journalistic franchise. "The more profoundly resonant the event," Mr. Fuller said, "the more people need to fit it somehow into an emotional or moral context." But the profound resonance of the Jonesboro shootings has not lent itself to equally profound responses. On one of the TV shows endlessly dissecting the event, Oliver North, the Iran-Contra figure-turned-politician-turned-radio-personality, said it was "unconscionable" for gun-control advocates to try to make political hay out of the tragedy. Then he substituted his own spin, saying that as a life member of the NRA and as someone who grew up "with a .22 rifle in one hand and a fishing rod in the other," the tragedy proved that the responsibil shrinks and social workers and counselors and the proliferation of . support groups we now have a - mob of meaning makers and interpreters of why things happen," said Larry Rasmussen, a professor of so-. -cial ethics at Union Theological Seminary in New York. There was a time when the religious community was the locus for .that, but now it happens all over the place. The question is whether that provides more clarity or whether something serious is lost amid all the , verbiage." There is, no doubt, something . entirely natural and even valuable in ,'the anguished analysis. In some ways, it helps fill an in- time to sit and think in an organic sort of way. It's a game with a leisurely pace that, thank goodness, has resisted most efforts to speed it up for short-attention-span Americans. Each baseball game is of potentially infinite length as, in fact, each at-bat is. And people who sit in the stands (or, if conditions in the house are right, watch a game on TV) have a chance to sort out the vicissitudes and vagaries of politics, religion, art, economics and Bill Clinton's sex life. I am convinced that when a cure for the common cold is found, the world will hear about it first when some fan in some baseball stadium leaps to his feet between innings to yell "Eureka! I've solved it!" Of course, the fan behind him or her almost certainly will ask why the name of Ronald Reagan's small-college alma mater in Illinois was just hollered out and whether Eureka College has a Paycheck protection' a reality on California ballot William Satire baseball team these days worth a hoot. This almost certainly will lead to a discussion of baseball's origins, because every baseball conversation, given world enough and time, leads to a discussion of the game's origins. : Did too. Did not Did too. Did not Which means someone will describe how Abner Doubleday invented the game in 1839 in a field in Cooperstown, N.Y. Friends (if you are friends), Abner Doubleday did no such thing. This is a myth even larger than the alleged federal budget surplus. I have even personally been to the Baseball Hall of Fame in Cooperstown, N.Y., where Mr. Doubleday allegedly invented the game, and can state that the only reason Cooperstown has the Hall of Fame today is that organized baseball fell in love with the Doubleday-Cooperstown myth in the depths of the Great Depression when a Cooperstown booster, one Stephen Clark, offered Jo build the hall and put on a baseball centennial celebration in 1939. ; The true inventor of baseball or at least as close to an inventor as we can get in a world where every idea requires rooting in many previous ideas was the New York sportsman Alexander CartwrighL You could look it up. ; So take me out to the ballgame. I love to s e millionaires do real work. Bill Tammeus is a columnist forlhe Kansas Chy Star. , 'The Supreme Court decided the issue a decade ago: Union members have the right to claim refunds of portions of their dues not spent on collective bargaining. If your union leader wants to contribute to a bill legalizing marijuana, and you're against pot smoking, you can get back from the unton that part of your dues that went to support what you oppose. That strikes most Americans as eminently fair. But try to assert your right in the real world; the shop steward will make you a pariah, and the CHnton administration, dependent on money from unions, will refuse to enforce your constitutional right A movement is sweeping the states to make that right a reality. In California, the initiative is called "paycheck protection." It would remove the burden of asserting that right from the rank and file; instead, unions would have to disclose where political con-Uibiitions are going, and workers could approve or say "not with my dues money, thanks." Hie prosjHvt of losing absolute control over directing union dues to l.beial candidates and causes is driv- businesses and executives out-contribute unions by 10 to 1, business money is split between both parties (about 55-45 percent favoring Republicans) while almost all union money rewards Democratic friends. What about stockholders who object to contributions by the companies they own? They are free to protest by selling their stock, but union members in a union-shop state cannot get out of paying union dues. Sweeney & Co. is in a panic for good reason: Polls show paycheck protection (a hard-selling description that union spinmeisters have failed to counter) running far ahead. The lead will surely narrow in the next two months as unions pour millions into attack ads (And you want this part of your dues back? Sue us) but Pete Wilson is ready for any "seal pup ad." The seal pup is legend in California media politics, much as LBJs TV "daisy sit" is remembered for unfairly clobbering Barry Goldwater. Democrat Willie Brown knocked down reapportionment years ago with a last-minute st showing a seal pup sullotating in an oil slick. 'I he, ad message: Redrawing district lines would elect anti-environmentalists who in turn would murder the cuddly innocents. The con job worked. The paycheck-protection brigade seeks to inoculate voters especially loyal union members of whom a third are conservative against a seal-pup attack. The plan is to define the workers' free-speech issue early, and warn of last-minute smears orchestrated by desperate union bosses in D.C. The Sweeneyites in the nation's capital, backed by a Clinton veto promise, can block federal legislation to carry out the Supreme Court's decision to protect the individual worker. But if labor's bosses do not stop paycheck-protection in the state of California in June, the prairie fire will spread through a score of states and consume Democratic control of union coffers. W ould such an outcome help ignite a presidential campaign for the governor who made it happen? Says Pete Wilson, whose voice is back: "Shouldn't hurt." William Stifire is a columnist rThe New York limes. f ing John Sweeney's AFL-CIO headquarters up the wall. By loudly announcing a "hit list" of Republican candidates; by helping launder money through politics for Ron Carey's corrupt Teamsters campaign, and by boasting of labor's financial clout, labor's new left-wing leadership invited a backlash. It has arrived. Gov. Pete Wilson of California is leading the fight to return political decision-making to the rank and file. He sees paycheck-protection Prop. 226 as "one of the great public services of my career" because it will curtail union power to block his proposals for education reform. Nail-nibbling GOP operatives worried that Wilson's crusade in the nation's largest state would unplug a deluge of dollars from AFL-CK) headquarters to defeat the referendum, perhaps burying Republican candidates on the ballot this November. Gov. Wilson neatly finessed that danger by putting the initiative on the primary ballot on June 2. t Although union officials argue that

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