AS AMERICA'S WEALTHY spend millions of dollars on unneeded medical care, as the stinging inadequacies of our health care system go uncorrected by milquetoast politicans, The poor ponder their choice: death by anecdote or by the numbers.
By anecdote: a local hospital refused to admit a pregnant woman because she lacked health insurance. She was in labor at the time.
By numbers: The United States spent $671 billion on health care in 1990, twice as much as in 1982. Twelve percent of our GNP goes to health care, more than any other nation on earth. At the current rate of increase, it will consume 37 percent of our GNP in 2030.
The problems of the American health care system are so huge and terrible, it is almost incomprehensible. Everything that is right with the system is going wrong. And everything that is wrong is getting worse. No one thing is responsible for the collapse of the system; no simple repair will fix it.
To save us from spiraling costs, apalling waste and needless suffering, America needs a complete overhaul of its unequal and ineffective health care system.
IT'S HARD to locate an ugly core to the American health care crisis: There are too many problems--administrative waste, lack of preventive care, misapplied technology--and they all seem to cause each other, creating a viscious uncontrollable cycle. But the current discussion of health care difficulties focuses on two primary problems: the plight of the uninsured and the skyrocketing cost of medical insurance.
An incredible number of Americans, 37 million of them, have no health insurance. They are poor, but not poor enough to qualify for Medicaid. They are not old or disabled, so they don't get Medicare. And for the 85 percent of them who are employed, or whose parents or spouses are employed, their firms are too small to provide any health coverage.
At the same time, the costs of medical coverage for those who are insured are going through the roof. Private companies that generally provide health insurance for employees are facing higher and higher premiums, which they pass on to their workers. Workers, in turn, get angry and worried about their ever more threatened ability to afford medical care.
BUT THESE are just the most obvious signs of crisis; the real calamities involve the meeting of these insurance problems and our actual health care system.
The first place insurance meets, or fails to meet, medical care is in preventive medicine. We don't have any.
Since our health care system is so fragmented, no single authority looks out for the national health. The federal government doesn't play a central role in public health, so it can't impose universal preventive medicine, even though spending a few dollars up front would save huge amounts later.
The uninsured have found that the best way to avoid paying for medical care is not getting any. Children go without vaccines, and then catch diseases that may cripple them for life. Pregnant women don't get prenatal care, and then bear expensive, unhealthy, premature babies. Women don't get mammograms, and die of treatable cancer.
When uninsured people do get sick, they let it linger, and get sicker and sicker, until they have to go to the emergency room and wait for hours behind the gunshot victims. Had they gone to the doctor a week earlier for a five-minute visit they couldn't afford, they would have stopped the illness in its tracks. Instead, they use emergency rooms for primary care, and help destroy already overburdened innercity hospitals.
The 37 million suffer, effectively rationed out of health care by an invisible hand at the beck and call of the crusading army of Blue Crosses and Blue Shields.
ANOTHER OUTCOME of the collision between insurance and care is excessive technology. Since medical procedures cost patients nothing up front and little later, there is no incentive for the insured to skimp on technology. Doctors want to maximize their fees by maximizing care, and they also fear malpractice suits for missing a diagnosis. As a result, they order as many tests as they can. Patients don't pay, so they want to get the most care they can. Insurance costs went through the roof, but we didn't care because we didn't have to pay up front.
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