AMERICA NEEDS NATIONAL HEALTH CARE POLICY; MORE THAN 80 PERCENT OF AMERICANS BELIEVE HEALTH CARE IS A RIGHT

The time has come for the United States to adopt a national health care policy. Already, more than 80 percent of Americans and Missourians believe that health care is a right. Although we will not find this right articulated in any federal policies or documents, we must recognize it as a goal that we must strive for together as constituencies and states.

There are a number of specific proposals on the table from bodies as diverse as the Pepper Commission, the National Leadership Conference, the Heritage Foundation, the American Medical Association, the American Hospital Association, and, more recently, the Missouri Health Care Forum which has proposed its statewide Blueprint for Action. These proposals enjoy a good deal of common ground and offer us an opportunity to make significant advances as a nation.

Insufficient coverage

Missourians are largely pleased with the quality of care and service they receive in their local Missouri hospitals and from their personal physicians. Their deep concern arises from a fear that should they change jobs or lose jobs and health insurance benefits, they would no longer be able to afford care for themselves and their families. Many Missourians already face this dilemma.

One in five Missourians either has no insurance or inadequate health insurance. These unsponsored individuals may not seek care when they need it; this delay in primary-level care all too often leads to emergency medical conditions that are far more costly to treat.

Today's decisions

There are some solid policy decisions that can be made today in Missouri to provide coverage for low-income Missourians. The shared federal and state Medicaid program provides an option to states to extend coverage to pregnant women and their infant children in families with incomes below 185 percent of the federal poverty level. Missouri's current coverage is limited to those with family incomes below 133 percent of the federal poverty level. Although Medicaid also provides states an opportunity to cover a category called "medically needy," Missouri has not exercised this optional coverage.

If Missouri made these two important expansions of coverage, it is estimated that 40 percent of currently unsponsored patients would become insured. The balance, 60 percent, should be addressed through federal and state tax incentives and other subsidies for private coverage which would include basic benefits covering preventative, primary, acute care, and long-term care.

Tax increase

Catastrophic coverage should be financed through increased taxation and/or appropriation of existing funds at both the federal and state levels. It should be underwritten by re-insurance mechanisms that assure appropriate payment to health providers.

Some of the essentially-related issues that we must tackle as individual states and a nation, include insurance reform so that workers who change jobs will not lose coverage due to a pre-existing condition, high-risk individuals will not be squeezed out of plans; and small employer groups will have the advantages of community rating.

Tort reform

We must also work toward medical liability reform so that money now spent in pursuing and defending malpractice litigation can benefit more appropriately those who are injured, and that we as a nation can forego the needless expense of care categorized as "defensive medicine".

Tort reform must place reasonable limits on judgments and awards, thus simultaneously providing for those truly entitled to recompense while enhancing the availability and cost of professional liability insurance to health care providers.

The Executive Branch, Congress, and state governments must assign financial resources, through the reappropriation of budget priorities, to the prevention of disease and the provision of primary care in both the public and private sectors. As a people we must raise individual lifestyle awareness so that illness can be avoided or dealt with at its least costly--and most treatable-- stage.

The medical profession needs to do significantly more research into medical protocols and efficacy in treatment methodologies so that technology and other alternatives are used appropriately and as needed thus avoiding the cost of inappropriate care. As a society, we need to better address social ills, such as drug and alcohol abuse, homelessness and violence--problems that become medicalized when their victims arrive at hospital emergency rooms.

And each of us needs to understand our own rights and responsibilities as individuals so we can make determinations about the kinds of care we would choose or decline in certain medical situations.

Not Canadians

As we undertake these challenges, perhaps the most important consideration will be to fashion solutions that are acceptable and welcomed by Missourians and Americans. We are not Canadians; we are different from them as a nation and as individuals.

Unlike the American population, Canada's population is quite homogeneous. Canada's trust and reliance on the government is complete, whereas Americans are skeptical of government's involvement in their lives. Canadians are more inclined to wait in line and on priority lists for tests and surgeries; Americans want immediate intervention. When Canadians feel their care is inappropriate they are less likely to sue than Americans. Because of this, a Canadian-type universal health care plan, run by the government, will not work here. It will please only the well while those who are ill decry the system and demand yet a second reform.

Biting the bullet

In a nation as prosperous as ours (with 80 percent of the population believing health care is a right), we must "bite the bullet" and make the hard choices as if we were ill. Politically popular or not, tax increases and budget appropriations ultimately will be required. Adequate and fair funding is the answer. Putting health care providers in the untenable position of being caught between fixed government payments and rising costs of medicine, food and the human resources needed for patient care will only continue to fuel the fires of discontent.

The health care system we build must be our own. It must reflect a blend of our philosophy, economy, ethics, and morals. America already has a great health care system that technologically is a model for all nations.

Undoubtedly, the aspects of access and affordability must be addressed in all of their complexities. Progress can be made if health care providers work with their communities and leaders at all levels. Working together for the common good is an American tradition. Improvements will be made in our health care system--perhaps not overnight, but with steady progress that will attest to a commitment on the part of health care providers, business and the general public to maintain the world's finest health care system.

James W. Wente, C.P.A., is Administrator of Southeast Missouri Hospital.