FOUR LOCAL DOCTORS CALL IT `RATIONING'

Four local physicians patiently watching President Bill Clinton's health-care-reform pitch Wednesday night agreed that behind the pomp and circumstance of the president's speech, the bottom line reality of the plan is rationing of health care for all Americans.

Speaking before a joint session of Congress, Clinton outlined the goals of a new plan which is about to embark upon a long and uncertain journey through Congress.

"What does all of this mean?" Clinton asked.

"It means diminished, rationed health care for which people are going to pay more," answered Dr. Gordon Eller, a Cape Girardeau physician.

Near the end of Clinton's hour-long speech, Dr. Mark Kasten observed, "He hasn't explained anything yet."

At the end of the speech, Kasten said: "It was an impressive speech, but he did not hit on the specifics of the package there was a lot of icing and no cake. But having gotten a sneak-peek at the documents outlining the plan, the whole thing bothers me."

Kasten and colleague Dr. Ed Masters both felt the proposed seven-person national health care board which would be established under the plan would be restrictive and ultimately destructive to health care as we know it.

"If we cannot meet the regulations and budgetary guidelines put forth by this board or the alliance for the region, we face the possibility of having to search out another alliance or rationing health care," Kasten said.

Masters added: "A lot of people seem to think that doctors are not responsive and accountable to our patients. But at any given time, if the patient is not completely satisfied with the treatment he or she is receiving, that person is perfectly free to get up and leave.

"But it doesn't work that way with the government in charge of health care," Masters continued. "If the government screws up, who are we to hold accountable? Are we to believe that the central government can make health-care decisions for the individual better than you and your physician? Is that what people truly want from a health-care system?"

Eller said people want effective, economical health care which they can afford.

"Things tend to become politicized within the government," Eller said. "The solutions politicians put forth are political solutions, not real solutions, and legislators have to keep that in mind if they are truly going to help the situation.

"My impressions of the proposed system are that we will result in rationed health care with waiting lists and denial of care to those who don't need it most," he said. "In the end, very few will benefit, and we will pay more."

Dr. Tom Sparkman said Clinton's proposals were nothing he hadn't heard at some point or another before Wednesday.

"Doctors had the same fears we do now when (former President Jimmy) Carter proposed his Medicare plan," he said. "When the legislators who are drafting this proposal are distancing themselves from being a part of its outcome, we have to be worried especially when they are trying to cram the package down the doctors' throats."

Masters added: "The whole thing looks marvelous from a distance. But perhaps we should all follow Clinton's caveat maybe we shouldn't inhale until we look at its side effects."

The doctors said they take patient issues to heart and have based their careers on a history of performance and effective treatment.

"Every day we are faced with the dilemma on whether or not to order a certain treatment or test, gauging its effectiveness and the benefits to the overall care and healing of the patient," said Eller.

"This package could restrict our ability to choose what tests we order and what kind of treatment people are able to receive."

John Fidler, president of St. Francis Medical Center, agrees with the basic premises of universal access to health care and finding a better way to finance it, but questions how the changes will be funded.

Fidler added that the debate has just begun. Discussions of what the final plan will include are expected to continue for a year.

"I hope we don't forget that health care is a local, caring process. We need to keep the heart in heath care with committed people dedicated to doing the right thing," he said. "In the final analysis, we still have the finest health care system in the world.

"We do have health care problems," he continued. "We need to reduce paperwork, malpractice lawsuits and the cost of defensive medicine. We need more primary care physicians and fewer specialists. WE need less insurance companies taking 15 to 40 cents on the dollar."

Whatever the final package, Sparkman said, "The main thing we are concerned with is the doctor being the patient's advocate. And patients should be free to choose their own doctors."