Saturday, March 7, 1981
The Michigan Daily
Edited and managed by students at The University of Michigan
Vol. XCI, No. 126
420 Maynard St.
Ann Arbor, MI 48109
Editorials represent a majority opinion of the Daily's Editorial Board
Democratic opposition to
budget plan threatens poor
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UST AS President Reagan's shaky
plan to slash the federal budget
threatens the welfare of the poor,
Democrats, in their uneven opposition
to the plan, may pose an even greater
The most immediate peril to the
security of the. poor, is Reagan's
budget-cutting scheme. But Reagan
advisers insist that, even though
almost every basic social program will
suffer significant cuts, the plan will not
have a seriously adverse effect on the
poor. The Reagan team claims the
"truly needy" will continue to receive
federal benefits while the marginally
poor will be able to finance the same
services they enjoyed before by tur-
ning to the private sector.
According to the theory, the massive
t x cuts that will accompany the
program reductions will allow low-
itcome and marginally poor families
t4 provide for their own welfare.
Although a family may lose its food
sump eligibility, for instance, its
lighter tax burden will allow it to buy
its own food without subsidies. Yet this
plan has two primary problems:
A " It is entirely based on untested
theory. The plan is really an economic
gamble - a gamble in which, as the
AFL-CIO executive council pointed
out, "the only sure winners are the
n The Kemp-Roth-Atax cut willlikely
sait in massive inflation which will
eftf ut the poct's ability to finance
its own welfare.
F So, one would expect the Democrats,
tie traditional political guardians of
Itie disadvantaged, to mobilize in fier-
e opposition to the plan. And, in a sort
LEGEND BID farewell last night.
After more than 19 years of telling
t e country "That's the way it is,"
Walter Cronkite gave his final broad-
A For many University students,
Cronkite represented their first ex-
posure to the news. Countless
childhoods undoubtedly were influen-
qed by what Cronkite said each night
dn the "CBS Evening News."
Cronkite's straight forward ap-
proach to the news was refreshing and
of half-hearted, lopsided way, they
have. As a result, the poor and near
poor may be in even greater peril.
The Democrats, still shell-shocked
and dazed from the Republican lan-
dslide last fall, seem unable or un-
willing to take too firm a stand against
the budget and program cuts. Instead,
they have limited their only real op-
position to the other half of the plan:
the tax cuts.
Apparently, they feel standing up to
the massive Kemp-Roth cut is safer
than sticking their necks out for the
poor in a time when much of the nation
has adopted the cry for less gover-
nment. Although their opposition to the
tax cut side of the Reagan plan may
save the poor from rampant inflation,
it also undermines what chance the
Reagan plan does have of working.
If they succeed in blocking or
significantly reducing the tax cuts
while allowing the bulk of the program
cuts to stand intact, the balance of the
Reagan plan will be destroyed. The ef-
fect would be to strip the poor and near
poor of most federal benefits while
denying them any real hope of finan-
The only hope for the poor and near
poor lies in well-organized, balanced,
and successful opposition to the
Reagan plan as a whole - in blocking
both the spending and the tax, cuts.
Socially responsible members of
Congress, both Democrats and
Republicans, must unite and begin the
real fight'to kill Reagan's plan, before
the plan plunges the nation's disadvan-
taged into Free Market economic
inspiring. Many people depended on
Cronkite for their only news.
Journalists nationwide have paid
tribute to this broadcasting institution.
Both ABC and,NBC, archrivals of CBS,
lauded the television veteran.
Cronkite's departure represents a
tombstone in the lives of journalists
across the country. Although he may
continue to do special features for CBS,
his nightly appearance will be greatly
Health care, fast-food style,
mushrooms inUnited States
SAN FRANCISCO-Working out of a con-
verted hardware store, Dr. Mitchell Koch has
accomplished the medically im-
possible-opening a successful private prac-
tice in downtown San Francisco. This city,
with more than three times the national
average of doctors, is "the most overdoctored
city in the United States, if not the world," ac-
cording to the medical society president here.
But Koch is not likely to win a Nobel Prize
for his efforts. Scorned by his competition as
the "7-11 of health care," K(och's Sutter
Medical Group works at the fringes of genteel
medicine where money must be made in high
turnover rather than high fees.
HE HAS PIONEERED a walk-in "minor
emergency clinic" in the heart of the city's
gay district, relying on fast treatment of
venereal disease and general physical exams
to carve out his niche in the medical market.
"We can provide savings of 30 percentto 50
p ercent over hospital emergency rooms
bcause of lower overhead and stricter fee
collection practices," Koch says. "And if
someone comes in with major trauma, we
can admit them'at St. Francis Hospital
around the corner."
"He's cream skimming-taking off the
easy 80 percent of minor emergency patients
that otherwise come to the hospital ER,"
another doctor says.
IN THE PROCESS, Koch is proving that the
free-standing "convenience clinic" concept,
inaugurated barely six years ago by Dr.
Robert Gordonin Rhode Island, can succeed
even in the densest concentration of hospitals
and private doctors. More than 150 minor
emergency clinics are now located in subur-
ban shopping centers or near strategic inter-
sections across the country, clustered
primarily in the Midwest, Texas and Califor-
Dr. Gordon owns four emergency clinics in
Rhode Island; Dr. A.J. Reed operates nine in
Kansas, and Dr. Karl Mangold of San Lean-
dro, Ca. has three walk-in clinics and more on
the drawing board. Dr. Henry Harper of
Houston owns four traffic-intersection clinics
in Texas, each with a large "MedStop" sign in
the form of a traffic marker. He intends to
open similar clinics under the "MedStop"
sign from coast to coast.
Most of these businesses are professional
corporations, owned and operated by doctors.
But in St. Louis, a hospital food and linen
company has bought a local MEC-and now
provides the medical doctors as well.
THE RAPID EVOLUTION of walk-in
By Thomas Brom
clinics, however, raises some troubling
questions about the nature of health care in
the U.S. They come at a time when dentists
are also incorporating, franchising, and
locating in shopping centers - joining op-
tometrists and chiropractors already there;
when health care costs for traditional
physicians have exceeded the means of the
great majority of U.S. families; when
American job mobility is at an all-time high,
undercutting the social base on which the
family doctor depended.
Finally, the convenience clinics reflect
changes in the crowded medical job market
itself. More and more health professionals
are leaving solo practice for wage labor in a
medical corporation not substantially dif-
ferent from most other businesses.
The net effect for the medical care con-
sumer is a short term reduction in costs.
Whether the quality of that care has also been
cheapened is open to debate.
"WE BELIEVE THERE is a social need for
these clinics," says Len Hamer, regional ad-
ministrator for two clinics recently opened by
"Oakland's California Emergency Physicians,
a corporation that also staffs and operates
emergency rooms in 31 California hospitals.
"The best analogy is to the fast food industry.
Quality runs from atrocious to very good. But
there is a difference between Burger Chef and
McDonald's - I'd choose Burger Chef
because the quality is better."
To a great extent, the high cost of hospital
emergency room care is the single biggest
factor in the creation of convenience clinics.
"San Francisco hospitals charge over $45 to
get through the ER door," Dr. Koch says.
"And that doesn't count room fee, x-rays, lab
tests, and medicine. We beat those charges
easily, and spend ten percent of our budget on
advertising to tell people about it."
DESPITE INITIAL opposition from of-
ficials at the city's 15 hospitals who saw the
clinic as an immediate threat to their
emergency rooms, Koch's main clinic - and
now a satellite storefront near the
predominantly gay Eureka Vallley - was an
instant financial success. The Sutter Medical
Group advertises heavily in gay newspapers,
competing with similar clinics that boast they
can treat "the Man Who Has Everything.,
But Koch has broadened his financial base
considerably through 150 contracts with
major downtown hotels, department stores,
and the MUNI trancit system covering both
workers and patrons.
Koch's success, however, has not come
without recriminations. Former employees
and co-workers complain of pressure to in-
crease patient turnover, each practitioner
commonly seeing 40-45 patients per 12-hour
shift. The main clinic is open from 8 a.m. to 8
p.m.,'seven days a week. "It's just like a fac-
tory," says one former associate.
The storefront on Sutter Street includes a
lab, x-ray equipment, and a pharmacy - all
owned by Dr. Koch. Medication is pre-
packaged in individual units and included in
the price of treatment; patients are not given
the option of buying medicine elsewhere.
FINALLY, THE CLINIC requires
payment by cash, check, or credit
card at the time of treatment.
Patients whoedon't have the money up front
are referred to hospitals that will bill them.
The "medical mill" rap; however, is
nothing new to low-cost health care facilities.
It has long been a criticism of both MeciCal
and Medicare clinics, and of the popular,
Kaiser Permante health maintenance
organization. High turnover, "epoisodic"
care is fast becoming the only kind most
Americans can afford.
"There's no real difference between what
Kaiser is doing and the shopping center
clinics," says Robert Rowland, executive
secretary of the California Board of Medical
Quality Assurance. "There is no major
pressure now to regulate the convenience
clinics, nor is there a need to. I think drop-in
clinics are the wave of the future."
Even the practitioners of convenience
medicine, however, admit that something is
lost. "A lot has changed since my father
began practicing medicine," Dr. Koch says.
"there's no time to really talk to patients any
"If you can generate a demand for fast
foods, you can generate a demand for fast
food medical care," adds a private doctor.
"But it's not the same. The most important
aspect of medicine is the personal relation-
ship and trust between patient and physician.
If the patient can't buy the time for that, he's
being victimized by the system."
Thomas Brom, a freelance writer,
wrote this article for the Pacific News
LETTERS TO THE DAILY:
PIR GIM needs financial support
To the Daily:
Please excuse me for the bitter
tone of this letter, but if you will
reflect on my experience,
perhaps you will find it under-
The Public Interest Research
Group In Michigan, under a
"positive check-off" system of
funding, takes in $12,000-$15,000
per year. $8,000 goes to the single
staff person, $2-$3,000 supports
the state agency, and the rest
covers basic office expenses.
That leaves just about nothing.
Every single cent for every
single project comes in through
additional fundraising. So not
only must PIRGIM staff CRISP
with 3 or 4 people for every hour,
every day for several months out
of the year, just to maintain a
decent return on positive
checkoff, but every project
PIRGIM plans must depend upon
voluntary contributions, like a
But PIRGIM is not a charity. It
dinate the 1980 Regional Housing
Conference held last October, on
which I worked 15-25 hours a
week for six months prior. A
great many of those hours were
spent trying to raise money. Four
grant proposals, on which we
worked for three solid months,
yielded about 1/5 of what we
A mass mailing, sent to almost
a thousand housing groups all
over the country, asking for sup-
port, received two responses. So
as every PIRGIM project
inevitably must depend on, we
stood on the sidewalks of Ann Ar-
bor with, those ubiquitous
buckets, begging people for
money, only to have students ask,
"What about the money I gave
PIRGIM at CRISP?"
The Housing Conference went
off not as smoothly, well planned
or well financed as it could have,
because of the inordinate and
fruitless time we spent begging
for money. The reason it went off
four months later?
I do not want to continue with
PIRGIM because, frankly, I was
tired of begging people for
money, which seemingly was 75
percent of my volunteer work
there, whether it was for the
Housing Conference, or for staf-
Yet the ironic upshot of this
whole situation is that we are not
asking the University for a pen-
ny. We are asking for a change in
the funding mechanism, to the
by which the student can either
refuse to support PIRGIM with
the first University bill, or get a
refund at a later date.
This is a fair and workable
system, as demonstrated by the
scores of colleges and univer-
sities across the nation that use
such a system, and would also be
consistent with the original'
student mandate of 16,000 petition
signatures when PIRGIM was
formed. Without such a change in
funding mechanism, PIRGIM
cannot give the students the type
of support and representation
that they deserve. It is certainly a
tribute to the tireless dedication
and volunteer hours of all
PIRGIM members, past and
present, that they can still point
with pride to a long and fine
record of accomplishments.
-Nicholas B. Roomeliotis
Defense investment OK
To the Daily:
I am writing this letter to make
Daily should fail to recognize