PASSAGE 36 Health Care Reform This fall the country will be talking health care again-or at least should be talking about it-as Congress moves to change the principles on which Medicare and Medicaid were established 30 years ago. A writer with a taste for irony could scarcely conceive a better plot, and as one of those who wrote the Clinton plan, I confess it strikes me as more than ironic. Two years ago, Republicans were denouncing the secrecy surrounding the President s health care task force. This summer, Republicans have been meeting "behind closed doors" on a Medicare proposal scheduled to be released later this month, only a few weeks before Congress votes on it, thereby avoiding independent analysis of the costs, mobilization by opponents and other inconvenient aspects of a long national debate. Two years ago, the Republicans rang alarms about the Clinton plan s emphasis on managed care. Now the Republicans own plans for Medicare and Medicaid emphasize managed care. But superficial similarities are deceiving. The reform plans of 1993 generally aimed to extend rights to health coverage and health care. The Republican proposals this year would retract rights that already exist. The debate two years ago reflected a widespread belief that the health care system needed reform. The Republicans, like many in the business world, now begin with the happy thought that the system is reforming itself and that Government needs to be more like the private sector. The health care system is certainly going through profound change. Health maintenance organizations and other forms of managed care are expanding rapidly. As managed care grows, demand for hospital care shrinks. Hospitals are merging, closing beds and cutting jobs. some new buildings stand vacant. The incomes of specialists in some areas are 0dropping, and primary-care practitioners are in demand. Once stubbornly independent physicians are selling their practices to hospitals and insurers or taking a fixed payment per enrolled patient and accepting the discipline of the corporation. 1. What is the writer s attitude towards the Congress s move to change the principles on which Medicare and Medicaid were established 30 years ago? A) Ironic B) Humorous. C) Sympathetic D) Critical. 2. The phrase "behind closed doors" in the second paragraph could best be replaced by which of the following? A) At home B) In secret C) In a room secure from attack D) In prison 3. Republicans have been holding meetings "behind closed doors" in order to A) mobilize support from their opponents. B) Prepare for the upcoming national debate. C) Release their proposals without running into any trouble D) Discuss the Clinton plan in a detailed way. 4. What are the Republican proposals aimed at? A) Extending rights to health coverage and health care. B) Providing every American with free medical treatment C) Depriving many people of their rights to free medical treatment D) Withdrawing rights that have existed for a long time 5. Which of the following is NOT true of the development of managed care? A) Nurses are in great demand B) Physicians are no longer independent C) Some new buildings are vacant D) Demand for hospital care is on the decrease. KEY: ABCDA PASSAGE 37 I m sorry, I Won t Apologize Almost daily, news reports include accounts of public figures or heads of companies being forced to say they re sorry. In a recent case, Marge Schott, managing partner of the Cincinnati Reds, at first did not want to apologize for her remark that Hitler "was good at the beginning but he just went too far. " Under pressure, she finally said that she regretted her remarks "offended many people". Predictably- and especially given her history with such comments-many were not satisfied with this response and successfully lobbied for her resignation. This particular use of "I m sorry" has a familiar ring. The other day my husband said to me, "I m sorry I hurt your feelings." I knew he was really trying. He has learned, through our years together, that apologies are important to me. But he was grinning, because he also knew that "I m sorry I hurt your feelings" left open the possibility-indeed, strongly suggested-that he regretted not what he did but my emotional reaction. It sometimes seems that he thinks the earth will open up and swallow him if he admits fault. It may appear that insisting someone admit fault is like wanting him to humiliate himself. But I don t see it that way, since it s no big deal for me to say I made a mistake and apologize. The problem is that it becomes a big deal when he won t. This turns out to be similar to the Japanese view. Following a fender bender, according to a Times article, the Japanese typically get out of their cars and bow, each claiming responsibility. In contrast, Americans are instructed by their insurance companies to avoid admitting fault. When an American living in Japan did just that-even though he knew he was to blame-the Japanese driver "was so incensed by the American s failure to show contrition that he took the highly unusual step of suing him." The Japanese driver and I are not the only ones who are offended when someone obviously at fault doesn t just fess up and apologize. A woman who lives in the country told me of a similar reaction. One day she gave her husband something to mail when he went into town. She stressed that it was essential the letter be mailed that day, and he assured her it would. But the next day, when they left the house together, she found her unmailed letter in the car. He said, "Oh, I forgot to mail your letter." She was furious-not because he had forgotten, but because he didn t apologize. 1. What was Marge Schott forced to do?