More on Medicare

Steven Hayward and Erik Peterson provided an excellent depiction of the history surrounding the origin of the Medicare program ("The Medicare Monster," Jan.). However, I must point out an error. In their examination of Medicare's attempts at cost containment, they disclose the commissioning of a study of "relative values" for medical procedures on which to base new reimbursement rates. That announcement is certainly out of date, since that study was completed years ago, and the Resource-Based Relative-Value Scale has already been implemented for physicians involved with the Medicare program.

In my book, What Has Government Done To Our Health Care?, I discuss at length the RBRVS and the economic effects it will have on the medical profession and the general public. The RBRVS is essentially a comparable-worth scheme for physicians, redistributing the wealth among general practitioners and specialists.

It will result in a government-skewed allocation of physicians as medical students scramble into specialties with the best reimbursement rates. In some cases, physicians have already dropped Medicare patients from their practices because reimbursement rates have not covered costs. Others are seeking early retirement.

Terree P. Wasley
Frederick, MD

I would like to commend Steven Hayward and Eric Peterson for their article. I was especially fascinated by the chronicle of former Social Security Chief Actuary Robert Myers's skirmish with House Ways and Means Committee Chairman Wilbur Mills over the original Medicare projections and the documentation of Myers's persistent use of optimistic assumptions despite strong admonitions by Mills.

This account is remarkable to me because, in all my years in the actuarial profession, I have never encountered an instance, save for this one, of a politician counseling an actuary to be fiscally more cautious and prudent. Even more remarkably, Mills had done the analysis to back up his assertions! It is tragic for us all that Mills didn't insist on using realistic projections.

The article also discussed the Public Trustees' attacks on me for, as the authors put it, "blowing big holes in the projections." What the authors didn't know is that Robert Myers is still around, and he has not been chastened by his clash with Mills, even though experience has proven that Mills's worries were justified.

Myers has joined the Public Trustees in their attacks on me for not endorsing their optimistic projections. In fact, he is my most severe critic, comparing the views expressed in my statutorily required actuarial opinion with shouting "fire" in a crowded theater. Before this article appeared, I didn't realize my dispute with Myers put me in the company of a man as distinguished as Chairman Mills.

Congratulations on a timely article that was both entertaining and illuminating.

Roland E. King
Chief Actuary
Health Care Financing Administration
Ellicott City, MD

Working It Out

The article on worker's compensation ("No Pain, No Gain?," Jan.) was generally well balanced and on point. As an attorney whose practice is largely devoted to the representation of worker's-compensation claimants, I too recognize that there are serious flaws in the system. Unfortunately, the article seems to imply that the problems in the system have been largely created by greedy claimants' lawyers and their fraudulent clients.

I cannot speak for the California experience, but I know that here in Pennsylvania worker's-compensation claims are vigorously defended. Indeed, the claimants' bar tries to ferret out fraudulent claims. Part of the blame should be laid upon the insurance industry, which has become lazy, bloated, and bureaucratic.

I served for five years as in-house worker's-compensation counsel to a major insurance carrier in Pittsburgh and saw firsthand the results of employing improperly trained, underpaid, overworked claims adjusters whose main focus was on fulfilling paper-keeping requirements rather than investigating claims. I saw many dubious claims paid while meritorious claims were defended to the death, for no valid reason. As for lawyers' fees, I believe that the bulk of the problem is with defense fees. Defense lawyers bill at an hourly rate and have a built-in incentive to run up defense costs.

In the long run, I do not think any reform will be successful unless we totally scrap the system and go to a completely voluntary system wherein workers would be free to choose their own disability insurance. Knowing what I know about insurance carriers, I am sure that there would still be plenty of litigation of those claims to keep attorneys busy.

Jack L. Cherkin
Pittsburgh, PA

While the "no fault" worker's-comp system may preclude tort claims against the employer, the plaintiffs' personal-injury bar, aided by their brethren in the state legislatures and on the state court benches, have found a new path to generous trial juries by suing those upstream from the employer, e.g., the suppliers, manufacturers, and designers of the equipment the employee may have been using when the accident occurred. The cost of this litigation is borne by all of us in higher prices paid for goods and services.

James McCafferty
Bellingham, WA

As a doctor of chiropractic, I am more than slightly annoyed by Charles Oliver's singling out of an Oregon chiropractor as the example of an abusive provider in the case of worker's-compensation fraud. I do not doubt that the chiropractor in question is an unscrupulous character, but I find it hard to believe that, in a country where M.D.s outnumber D.C.s more than 10 to 1, the only example Oliver could find is the one above.

In my practice, I see scores of patients who have had unnecessary spinal surgery, the cost of each falling in the six-digit zone. It would be impossible for the most crooked of chiropractors to make a dent in the cost of one surgical procedure. Worker's compensation happily pays for all this surgery.

I do not say any of this in defense of the chiropractor previously mentioned; he broke the law and should pay for it. But I object to the implied slander against my entire profession.

Charles A. Krieger
Astoria, NY

Praising Paglia

Congratulations to Cathy Young for a fine appraisal of Camille Paglia's talent, insights, and shortcomings ("Paglia's Personae," Jan.). Paglia is an exciting, dauntless writer and thinker. But she seems to write before she thinks, and to will before she writes. I don't think she even knows where she is going sometimes. This means that she is atavistic, as well as a brilliantly discursive communicator. Indeed, not since the high, hot-volcano days of that self-creating androgyne, Alice "Ayn Rand" Rosenbaum, has a writer-warrior-thinker struck so many of my nerves at once.

As Young points out, Paglia is a performer, but how else to grab attention in a time when rightist religiosity, insipid sentimentality, and leftist anti-individualism passes for culture? If some of Paglia's "wacky" ways mean that she will not be taken all that seriously in our time—so what? Why should she give a hoot?

Paglia's true time awaits her a proverbial thousand years from now, and she knows it. The future, far more than history, is passionate, pagan Paglia's source of light. May she remain incandescent.

Cliff Vining
Santa Ana, CA

Cathy Young's excellent review of Camille Paglia hits upon the most intriguing and puzzling thing about her: the "thicket of contradictions" where we find Paglia apparently bouncing back and forth between "neocon" rationalistic moral sentiments and exhortations to libertine, sado-masochistic practices. Young does not resolve these contradictions and perhaps thinks that they cannot be resolved. Does Paglia have a theory behind such apparent confusion? Yes, she does, and it is a tribute to her depth and, I hope, ultimate importance as a thinker.

Sexual Personae is actually entirely about androgyny, otherwise the Holy Grail of feminism. But Paglia cautions that androgyny as we find it historically is mostly immoral, dangerous, destructive, self-absorbed, and unsympathetic. From anyone else, that might seem like a condemnation. But then that is what is different about Camille: She likes it. It is very creative and produces great art. At the same time it is necessarily not for everyone, not because it shouldn't be allowed, but because most people realize they would be crazy to try it.

Paglia says that she endorses "aestheticism and decadence," but her aestheticism is not an amoral aestheticism: She is ready, willing, and able to make moral judgments that are completely independent of her aesthetic judgments, and the reader is often whipped-sawed between what might seem like incompatibly moralistic and aesthetistic passages. That is what is great about her: Art can be troubling and even hideous, but good as art, even while we are in full possession of our moral judgment.

This gives us, indeed, a tragic sense of life. Great art has a cost, and libertarians especially should be aware of the tradeoffs involved. Camille Paglia realizes that there are costs—costs to art, costs for career women, costs for just about every good thing in life—but she is willing to pay them without complaint and without the "victimology" of so many people who want goods in a utopia without costs and without responsibility.

Kelley L. Ross
Van Nuys, CA

Fossil Facts

The facts as presented in "The Fossil Gestapo" (Jan.) vary considerably from those reported in The Los Angeles Times. The Times reported that rancher Maurice Williams leased the land on which the fossil was found from a tribal organization. But Jonathan Karl says the fossil was found on property that Williams had bought "from a white homesteader in 1969."

According to the Times, Cheyenne River Sioux officials maintain that Williams sold resources which were not his to sell. It was no different than if he had sold mining rights for gold, uranium, or coal.

The federal government, in turn, may have an ownership interest in the fossils, depending upon who has title to extractive resources found on this reservation. On all Indian lands, ownership of these resources—whether petroleum, uranium, fossils, or antiquities—is an ongoing and unsettled problem.

Many people do not own the mineral rights to their land, and sometimes, as in California's Owens Valley, not even the water rights. If the federal government asserts ownership of fossils and antiquities on Amerindian reservations, this does not mean that "Indian property owners on reservations have no property rights."

At any rate, currently many Cheyenne River Sioux receive oil royalties from longtime leases approved by the U.S. government. Oversight and ownership are not the same thing. In this case, the federal government certainly has the right and duty to oversee resource transactions.

Mr. Karl, in his zealous advocacy of the Black Hills Institute's purported property rights, has ignored the property rights of the Sioux nation and the American nation.

W. Snow Hume
Fullerton, CA

Mr. Karl replies: Mr. Hume treats the discovery and excavation of a priceless T. rex fossil as a legalistic matter of the federal government's "ownership interests." The central point is this: If the Black Hills Institute did not discover and spend tens of thousands of dollars excavating the T. rex, it would have been destroyed eventually by the wind and rain of the South Dakota prairie. The "property rights of the Sioux nation and the American nation" would not be at issue, but a scientific treasure would have been lost forever. That is what happens when a nation considers its property rights more important than those of its individual citizens.

Maurice Williams did not buy the disputed land in the way I reported, nor did he lease it as Mr. Hume says. Rather, he became owner of the land after exchanging it with the tribe for property he had purchased from a white rancher. But while Mr. Hume dwells on this distinction, a scientific marvel remains locked up in government crates.

Cultivating Freedom

Environmentally concerned taxpayers should turn eager eyes and ears to the Sand County Foundation's independent and practical thinking (Trends, Jan.).

The foundation's practice of letting previously cultivated land return to its natural state without conservation assistance from government stands in refreshing contrast to farmers who receive, in the name of conservation, federal money to let parcels of potential farmland go uncultivated. To compensate for lost crop production, some of these farmers overplant the land that they do cultivate. The results? Soil exhaustion and erosion problems. And who pays to fix these problems that government helped create? You have one guess.

Stanley Flynn
Rockville, MD