November 12, 1991

Secretary of State James A. Baker 3d called on Japan today to assume a more active role in protecting democracy and advocating free trade, instead of relying on "checkbook diplomacy" to protect its narrow interests or waiting for foreign pressure to force it into action. "We recognize that Japan's leaders, and its people, are now grappling with a difficult adjustment in Japan's world role," Mr. Baker said in an address to the Japan Institute for International Affairs.

In Dr. Stephen P. Kelly's red-brick office building here, medicine's past shares space with medicine's future. This is a doctor who still makes house calls. Yet as he leaves to visit ailing patients, he passes a computer that contains the billing requirements of 16 health-care networks, each of which has different rules about how much he can charge and what procedures he can perform. Dr. Kelly cannot continue in this medical time warp much longer. He feels an obligation to join the networks, he says, because his patients' employers have joined them, and this is the only way he can keep his patients. But the networks pay less than his customary fees, which means that he has to see more patients, going farther afield in Westchester County, to maintain his income. That leaves him less time for the patients he was trying to serve in the first place.

PAINFUL CHOICES FOR PHYSICIANS As more and more companies in the New York region join "managed care" networks -- organizations that require patients to choose from a set list of physicians, and physicians to charge certain fees for certain procedures -- doctors are facing painful choices: personal care vs. volume, autonomy vs. income. Like so many other changes in health care, this one reminds doctors of something many prefer to forget: medicine is a business, and a difficult one at that. Page A1. NEW YORK CITY U.S. REPORTS MOB DEFECTION In what some law-enforcement officials describe as the American Mafia's highest-ranking desertion, Salvatore Gravano, identified as the No. 2 leader in the Gambino organized-crime family, is expected to be a witness against John Gotti. Page B3.

A Federal agency has agreed to provide partial insurance against expropriation, political violence and currency convertibility problems for an American investment fund that plans to purchase $250 million worth of minority stakes in the commercial affiliates of Soviet companies in the military industry. James D. Berg, executive vice president of the agency, the Overseas Private Investment Corporation, which is known as OPIC, said today that the agreement was reached on Friday and represented the agency's first dealings on investments in the Soviet Union.

U.S. Agency Will Insure Investment in Soviet Union A Federal agency will provide partial insurance against expropriation and violence for a $250 million investment in Soviet defense affiliates. Page D1. Of $45 billion pledged to Eastern Europe by wealthy nations since 1989, 20 percent has been paid out. Page D9. Parliament Overrides Yeltsin The Russian Parliament overturned Boris N. Yeltsin's declaration of emergency in Chechen-Ingushetia and authorized talks. Page A10. Questions at the C.I.A. The Central Intelligence Agency gets a new leader today, and his effect on morale at the agency remains very much in dispute. Page A20. Ex-Episcopal Bishop Dies The Right Rev. Horace W. B. Donegan, the Episcopal Bishop of New York from 1950 until 1972, is dead. He was 91 years old. Page B8. Gotti Aide Said to Defect John Gotti's right-hand man will testify against him at a Federal racketeering trial, law-enforcement officials said. Page B3.