Contrary to Phillips' arguments, the independent Institute of Medicine, part of the National Academy of Sciences, not this writer, the managed care industry (if there is such a thing) or the former leader of the Veteran's Administration Health System, has reported extensively on the serious and well-documented problems of quality and safety in health care. The writer ignores the fact that most health care leaders, including myself, argue that the safe and effective management of patients must be directed by physicians with other health care professionals rather than by insurance companies or large organizations. He lumps for-profit and not-for-profit health care organizations together, although not-for-profit organizations, like the one with which I am associated, operate under strict laws, regulations and public scrutiny that make us different in purpose, practice and public accountability from our for-profit competitors. He doesn't acknowledge that so many distinct health care financing and delivery organizations are now lumped under the term "managed care" that the designation itself is meaningless.
Phillips does not mention that Kaiser Permanente was one of three health organizations that first called for a national Patient's Bill of Rights; nor does he point out that we have worked diligently since then to support the very legislation which he advocates. He fails to indicate that several years ago we joined with his specialty organization to propose and help pass landmark legislation that lets patients, not insurance companies, determine whether or not they have an emergency condition. That this was done over the objections of virtually all of our colleagues and competitors was not noted either.
It is easier to imagine villains at work than to expend the effort to understand what underlies the nation's health care malaise. Our nation's health care system is at a crossroads: our financing system leaves an increasing number of people without insurance or with inadequate insurance; too many of our nation's health professionals are demoralized; our delivery system is expensive, often unreliable and too frequently unsafe. Unfortunately, Phillips chooses to point fingers rather than provide useful information or insight. He has constructed a fantasy world that would be amusing were it not so misleading, pernicious and personal.
David Lawrence, M.D. '62<br>Chairman and CEO, Kaiser Foundation Health Plan and Hospitals, Inc.
<b>Paper diploma demand rises</b><br>The lead headline of the last issue of The Student read: "Few seniors choose paper diplomas" (March 14). A more accurate headline would have been: "Few seniors return diploma forms," for as the article revealed, only 83 out of 419 seniors even bothered to return their forms. This low rate of return came as no surprise, given that the form provided no return address and, as most students' name, hometown and major were printed accurately, there was little incentive to return it.
Of those who did return their forms, 71 percent requested paper. We might say that since the form was supposed to be returned by all seniors, those who did not forfeited their right to have their vote counted. But this argument would be unfair. Because the form declared sheepskin the default and required special notice from those who preferred paper, students who preferred sheepskin were not likely to return the form at all.
Yet as a result, all forms that were not returned were seen as representative of students who strongly prefer the sheepskin tradition. This is akin to an election in which non-voters are counted as having supported the incumbent candidate. It creates an inevitable and insurmountable advantage for the status quo. In fact, many seniors had a slight preference for paper but weren't adequately motivated to bring their forms to the Office of the Registrar in person. Others had no preference about diploma material and so did not return their forms, but would have been equally happy with paper. Still others returned their forms late and had them refused.
Given these shortcomings, what conclusions can we draw from this year's faulty forms? That 59 seniors-14 percent of the class-went out of their way to demand a paper diploma. The Student's headline presented the count as a defeat for paper when in fact it represents remarkable progress over years past, in which only a handful wanted paper. Hopefully, next year, the College will present paper and sheepskin as equal choices and stop counting non-votes as if they were votes for sheepskin.
Megan Anshutz '01<br>Ned B. Friend '01<br>Jed Horwitt '01<br>Tom P. S. Kingsley '01<br>Serena Laws '01<br>Marina Libel '01<br>Kimberly Shearer Palmer '01<br>Andrew Pirie '01<br>Jennie Vosacek '01<br>Noah T. Winer '01<br><i>five others signed this letter</i>
<b>Humanity appeal denies reality</b><br>Excuse me, Mr. Lennon, and now Mr. Osborne ("Humanity: A simple solution to violence," March 14) but love is not all we need. I certainly admit that on some level 12 hugs a day is a handsome ideal, but if this warm, fuzzy, romantic, mind-over-matter elixir really marked the be-all-and-end-all of our problems, then you could be sure Procter & Gamble would be selling it by the armload. I have more faith in Anton LaVey than I do in this kind of thinking.
We first say, "It's simply those foolish people who can't wish away their material conditions," and then, "Why are those young hooligans in the filthy ghettos always so senselessly violent? Such lack of family values; such lack of propriety; such lack of intelligence." Then, "It's simply those lazy mothers who can't walk like brothers." (Have I got it right, Mr. Osborne?) "Why can't they?" And finally, "they should be more like ... "
Well, you can see where this kind of logic takes us. Yes, indeed, toward a Barney-esque heroic humanism. I guess not so obviously, the truth is that there are no easy solutions. When we've discarded this junkie quick-fix notion that all the inexorably complex economic, social, sexual, gender-related, age-related and other innumerable inequities and inequalities are merrily, merrily, merrily but a dream, only then can we really get down to business.
Josh D. Friedman '01