Show 1 CIMMENTki Editorial Desk: li' lAYPTIkalw4-- Zbrattl:akeZribunt o EP ITORIALS Over Impending 1 their choice of physicians has been stricted With reform they're likely to lose tax deductions for health insurance and face even tighter restrictions on health benefits The wisdom of excluding special interests as well as the public from government deliberations can be seriously questioned Yet the task force is not ignoring involved interests Health-car- e experts are being consulted — on the task force's own terms The history of US health-car- e policy demonstrates a need at least to keep powerful lobbies at some distance during the development of proposals meant to put the general welfare first Reform will fail without effective cost controls If the AMA can prove that other cost controls are superior to national caps it should produce the evidence Among other options the AMA wants to preserve the failed method by which doctors charge for each procedure performed Yet many American physicians favor spending caps for health care The American College of Physicians which represents about 77000 internists has endorsed the idea So has the American Academy of Family Physicians This support may be related to the fact that these doctors as primary care physicians would play a key role in managing the health care envisioned by the White House's favored reform proposal Many already are accustomed to health maintenance organizations They are the least able to afford the rising expense of uninsured or charges While growing numbers of patients live in poverty and lack ready access to the health-carsystem physicians' incomes are rising much faster than inflation Between 1983 and 1991 physicians' mean income nearly doubled to $170000 a year (Surgeons were making $234000 in 1991 compared to the family practitioner's $111000) Like other special interests the AMA has been left out of the Task Force on National Health Care Reform led by Hillary Rodham Clinton AMA leaders now are warning that doctors will resist certain proposals including a temporary freeze on physician fees and strict national spending limits for health care They want patients to share in whatever sacrifices are necessary for e gate-keepin- g underinsured patients The point is however that the AMA cannot count on calling the shots in this round of health reform If members are too and antagonistic the organization's credibility will suffer Besides losing any "war" it might declare the organization would give up its power to positively influence health-car- e policy self-interest- reform Patients have been making sacrifices for some time Their share of health costs has steadily risen the past several years cutting into disposable Italy's Comic Political Opera hands in the till If Ross Perot is looking for a government clean-umission he should go p In the meantime the investigating magistrates who have unraveled the national scandal for the past year — it all began in February of 1992 when they stung a Milanese politico for taking a bribe in return for a city contract to clean a senior citizens' home — face a daunting choice They can continue to pursue politicians and bring criminal charges against them or they can seek a "political solution" which means offering the corrupt officials amnesty if they confess repay the money they took and bar themselves from future political office to Italy He would be busy a very long time The Italian political system is cruminvestigation bling amid a year-loninto a widespread scandal — mainly kickbacks on construction contracts that has touched high governmerit and party officials about a quarter of the members of Parliament and many business leaders Estimates of how much the rampant corruption has cost the Italian economy over the past dozen years run as high as $20 billion The corrosion of Italy's political system marked by seemingly daily reports of new arrests in the mushrooming scandal should in any event be seen as a positive development After all the current government is the country's 51st since World War II in a system of party patronage that has succeeded in keeping the Communists away from the reins of power but has engendered its own brand of corruption But the problem for Italy now is how to get from Point A the current system in which the many political parties are so entrenched to Point B a system that would serve the public without thievery For starters Italians should resolve to vote next month in a referendum on electoral reform supporting a more practical system of party representation in government As it is now some 16 parties led by the Christian Democrats and the Socialists are represented in Rome fostering not only splintered government but also a lot of g " 4 At -- 1 a ---- ' - - I r3 r" - e 3- 'gAl- 6 -— ' t k- al OF 1 ' catm :!) 1( -- ' ' - I1 Et6e' ! 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One would expect those on the right who most loudly lament the loss of civility to be the most sympathetic to Bowman's complaint After reading Bowman's article I conducted an unscientific survey of female acquaintances asking if they were in fact bothered by "street harassment" None was as distressed as Bowman is But almost all said they were regularly harassed at least on the "hey baby" level And most said they changed their routes to avoid public spaces where they thought they would be taunted For all her foolishness Bowman has pointed up a violation of civility that seems to diminish public life for a large portion of the population The problem is what to do about it The pursuit of civility in public spaces is a difficult enterprise for Americans accustomed to framing such issues as conflicts between individual rights Quite simply it is impossible to describe the civil ordering of public space in terms of "rights" I'm walking down the street talking to a friend A stranger walks up and begins to harangue me I turn my back He keeps haranguing I have a "right" to be there He has a "right" to be there too We both have "rights" But something has to give Worse the question of whether we want to restrain the haranguer inevitably hinges on the content of his expression It makes a difference if he says "Hello baby" or "Hey bitch" It even makes a difference if he's funny or trite The required judgment is almost aesthetic It won't do to simply note with liberal communitarians such as William Galston that "there is a gap between rights and rightness that cannot be closed without a that invokes richer moral vocabulary principles of decency'' That's true But how do we get ourselves a public sphere that reflects this decency? At least three approaches seem to be Amitai Etavailable First zioni in his forthcoming book The Spirit of Community despairs of any attempt to put a "notch" in the First Amendment to allow the prohibition of offensive speech But he suggests why not require offenders "to attend classes that will teach them civility?" This may make sense in a university setting (which is the context of Etzioni's discussion) As a remedy for "street harassment" it seems pathetically inadequate There's also something creepy about the idea of classes Second as Bowman suggests we might give "targets" of street harassment the right to sue for civil damages Yet this seems a recipe for gross litigiousness Do we really want every woman who feels "dissed" to be able to require a judge to assess the "reasonableness" of the dissstate-sponsor- ing? The third and least unsatisfactory approach is to delegate the required judgments to the police by making "street harassment" a misdemeanor just as other sorts of public disturbances are misdemeanors Pennsylvania already has a law penalizing anyone who intentionally "engages in a course of conduct or repeatedly commits acts which alarm or seriously annoy" another person The trouble as Bowman notes is that this sort of ordinance typically applies only to those who repeatedly harass a single individual not to those who harass a series of passersby But this defect can be remedied If it's not a violation of the First Amendment to arrest a man who calls one pedestrian a "bitch" 15 times why is it a violation to arrest him if says it once to 15 different pedestrians? Few police departments would actual-- ' ly arrest any but the most egregious violators of course But the law would at least give cops a basis for telling offenders to "move along" And the law might also stimulate the cultural change that everybody including Bowman agrees is the only real solution Until then her argument will be hard to dismiss Spendthrift Gore Isn't the Guy to Trim Waste CHICAGO TRIBUNE SERVICE Let's say you are up to your eyeballs in debt But you want to spend less and have a more frugal lifestyle Seeking advice you decide to consult a financial expert So a brief quiz: What kind of expert would you go to? (Pick one) 1 A certified public accountant 2 A Polish cleaning lady 3 A wild and crazy playboy If you picked 1 or 2 you are a normal rational person If you picked 3 you might consider running for president of the United States some day As you may have heard President Clinton has vowed to hunt down waste and sloth in the federal government Our money will no longer be frittered away In making this dramatic announcement he said: "We'll challenge the basic assumptions of every program Does it work? Does it provide quality service? Does it encourage innovation and reward hard work? We intend to redesign to reinvent to reinvigorate the entire national OM clear-thinkin- g government" That's a pretty good idea although it isn't original Every April 15 millions of Americans have the same thought although they might phrase it a bit more luridly And if Clinton fulfills this promise the country will owe him a standing ovation (Except for those bureaucrats who suddenly would find themselves in the cruel world of private enterprise) But I'm puzzled by Clinton's choice for the person to lead this crusade against waste and inefficiency: Vice President Al Gore Not that Gore isn't a fine young man — energetic intelligent polite and However in choosing someone for any job the person's background should be considered And Gore for all of his qualities doesn't seem suited for this chore ' As ' Voinoill A Mike Royko 4 idi penny-pinchin- g well-scrubb- '- '141 aS1A1-1-TYP- Z ARL 1 ' : ill' - 44 -- Ilr-- '( '4431:74rarecr DELFOILN A ' -- Targ 4 fi 7t --- - ' s' --- 1 ' -- 21- - 1 ' ''-- - 94 t NE -- -- A-4- 41F‘ Fa?1415AUTOrpg ' - '74W413t: AtEwANT IliiralgBucK )L1 -- - ' ---t - --: P1115 4'4 ak) - --- mEg - -- -k t-- ' - Aii -- -- — opera fl- ' 1 vock VP f- -t 41E6 041 0ckRA' - : The scandal has exceeded the toleration of the most cynical Italians Public sentiment seems to favor a thorough house cleaning The country should accept the distasteful "political solution" and get this gang of politicians out as quickly as possible paving the way for government reforms capable of protecting the country against any encore to this comic but unfunny 0 0 (IQ 9t()11 4 : 44 That such a deal can even be considered only underlines how widespread and tangled the corruption is So far those who have either been arrested or have resigned in the wake of the investigations include: the health and finance ministers in Prime Minister Giuliano Amato's cabinet two leaders of major parties including former Prime Minister Bettino Craxi two senior executives of Fiat and the mayors of Rome Naples Milan and Turin - - : f A - -- r re- policy-maker- -- : 4- health maintenance organizations they influence hospital 1 Ito- e Alk -- income As more have been steered into high-price- d 14 - FOR - American Medical Association leaders demanded to be heard last week concerning national health reform AMA Executive Vice President James Todd said doctors might "go to war" if too much "change" is loaded on physicians Let there be no mistake Life as American physicians know it must change war or no war It already has changed drastically from the days when patients developed lifelong relationships with doctors and kept ahead of their medical bills Now specialists dominate the market It is possible for surgery patients (or their insurers) to be charged for the services of physicians they've never even met Some 37 million Americans lack medical insurance and medical emergencies frequently drive families to bankruptcy Physicians are at the heart of tocrisis They are the day's health-car- e ones who control the tests and treatment of their patients They set the s prices of their services and as - ' ":z Reforms Health-Car- e :- tTii This Nation's Doctors Can't Afford 'War' t- A10 TUESDAY March 9 1993 237-201- 9 When he was only 28 — a mere lad by political standards — he was elected to Congress And that's where he was — eight years in the House and eight more in the Senate — until Clinton made him his Tonto That means Gore has spent most of his adult life as a member of Congress But even earlier he knew his way around that zoo because his father was in Congress for 32 years At an age when other kids were collecting baseball cards Gore could name the members of the Lobbyists Hall of Fame As a political writer put it Congress "became the family business" The trouble is Congress isn't a business and it isn't run like one If it was a business it would have been bankrupt long ago and all of its members would be homeless street people What Congress is best known for especially in modern times is spending other people's money And when it's out of money it runs a tab There isn't another group of people in the world who can spend money as avidly as Congress Now Clinton expects Gore who voted on billions of dollars in federal programs to poke his head into government offices and say: "My goodness what are all you people doing here?" And he's supposed to go to his and his father's former cronies and say: "Boys the old days are over No more grants to study the mating habits of gerbils or sleeping habits of cockroaches And not another $58 million in tax breaks to bail out George Steinbrelmer Honest guys the party's over" pork-barr- i 1 it uslred el Sure he will And I will slam dunk over Michael Jordan No it is a slick public-relation- s gesture and nothing more Somebody in the White House must have noticed the proliferation of bumper stickers that say "It's the spending stupid" They even installed an 800 number so citizens can call some bureaucrats with ideas for cutting bureaucratic costs Sure the typical guy is sitting around Pe- oria studying the federal budget If Clinton wasn't such a kidder he'd trot that little Stephanopoulos fellow down Connecticut Avenue to the offices of The Citizens Against Waste and pick up the latest copy of their annual Pig Book As tire group said in its news release about congressional gluttony: "Some of the projects highlighted in this year's Pig Book include a pair of bike paths in affluent North Miami Beach costing taxpayers $800000 two movie theaters in Savannah Ga renovated for a cool $2 million and another $13 million for Pennsylvania's 'Steamtown' a Scranton tourist trap of dubious historical significance" And those are items Congress considers mere baubles The bigger-ticke- t items — the billions for a useless space station and the super collider — already have been declared untouchable by Gore If Clinton was serious about this he wouldn't be asking Gore to overwme a lifetime addiction to spending other people's money and suddenly become a nick- Instead he'd bring in outsiders This country has no shortage of hard-eyebusinessmen and executives who know how to shrink a budget Many would relish an opportunity to shrink a bureaucracy that has caused so much shrinkage in their own businesses But maybe I'm wrong Maybe Gore will : be transformed into a fiscal hit man and' in a few months will zap billions in waste Sure And maybe with bouncy new shoes I really can dunk over Jordan d : i |