Tax increase: Let the people decide

Editor: The very incisive analysis by Michael D. Klemens (pp. 6-7, 12-14) of the tax stalemate between Gov. James R. Thompson and House Speaker Michael J. Madigan — and the budget problems resulting from it — seems to suggest that the question of a tax increase should be submitted directly to the voters in a referendum, which is, after all, the basic tool of democracy, designed to resolve such conflicts. If it is done that way, then, whichever way it turns out, democracy is the winner. Instead of arguing with each other, the governor and the House speaker would take their cases to the people — an arena in which Gov. Thompson's courtroom skill and Speaker Madigan's parliamentary skill can be put to very good use.

The governor's opposition to welfare grant increases, however, is mean-spirited in the sense criticized by the Physician Task Force on Hunger in America in its book Hunger in America: The Growing Epidemic (Wesleyan University Press, 1985) and by the "Perspective" section of the Chicago Tribune (February 5, 1989). One could easily get the impression that Thompson treats GA recipients (unemployed people on General Assistance) like a prosecutor treats convicts.

Years ago already, U.S. Sen. Edward Kennedy (Dem., Mass.) said, "We want social decency, not social Darwinism." It's time that rule was applied to welfare recipients in Illinois, as well as in other states.

Rural health care alternatives

Editor: I enjoyed reading Anthony Man's article about rural health care and would like to comment on the development of alternative delivery systems as a way of dealing with rural health care issues.

An innovative approach to rural health care problems is the expansion of prepaid health plans, such as health maintenance organizations (HMOs), to rural areas. This usually occurs as urban-based HMOs expand into rural areas. The typical plans are individual practice associations (IPAs) featuring private practice physicians in rural areas who agree to provide services to HMO enrollees for discounted fees or a small degree of shared financial risk, or both, and who adhere to standardized procedures for certification of hospital admissions, utilization review and quality control.

The development of HMOs in rural areas could help rural hospitals retain patients in their communities. This would increase the census and financial viability of rural hospitals. Further, physicians in areas of medical care shortages tend to be more supportive of HMO development, viewing HMOs as mechanisms for attracting additional medical resources in the community.

The state of Wisconsin is one example of aggressive HMO expansion into rural areas. Of Wisconsin's 72 counties, 53 met the census survey definition of rural and all are served by at least one HMO. This degree of penetration of rural areas by HMOs clearly is not the norm. However, it does indicate that rural areas — in at least some part of the United States — have become attractive markets for the recruitment of new HMO enrollees. A report by the Illnois Department of Public Health indicates that 34 non-metropolitan counties are in HMO service areas.

It would appear that the expansion of HMOs into rural areas could help to prevent the erosion of rural health care systems in Illinois. However, further studies are needed to determine the effectiveness of HMOs in terms of providing access, quality and cost-effective health care to the rural communities of Illinois.

Delaware tolls higher

Editor: Your article in the April 1989 issue "Illinois toll highways: Will they ever be free ways?", has a major error in the table on page 10.

The Delaware Turnpike figure should be $0.0909 not $0.0209 ($1.00/11 = $0.0909) The text makes this clear at the top of the second column on page 11.

I'm sure others will mention this.

Howard is still with us!

Editor: A second reading of the story on The Rockford Institute reveals that the caption to the photo on page 20 refers to "the late John Howard." John Howard, of course, is quoted in the story and is very much alive.

We are very pleased with the article and the manner in which we were treated, and I cannot thank you enough for the job of journalism you folks did.

Readers: Your comments on articles and columns are welcome. Please keep letters brief (250 words); we reserve the right to excerpt them so as many as space allows can be published. Send your letters to:

Caroline Gherardini, Editor
Illinois Issues
Sangamon State University
Springfield, Illinois 62794-9243

June 1989 | Illinois Issues | 10