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Dr. Anthony Zoffuto is a Cape Girardeau physician.

Health is the state of normal physiologic, anatomic, and emotional being, a gift. Disease is the state of dysfunctionally altered physiologic, anatomic and/or emotional being.~ Health insurance does not exist since no amount of money can ensure the state of health.

Commercial insurance is a social convention whereby a group of individuals bands together to share financial risks which could be incurred by an individual or individuals in that group. Insurance covers a wide variety of calamities including sickness and accidents which can befall an individual. Insurance neither prevents occurrence nor eases suffering. It merely partially protects against financial loss.

I like the analogy of skyrocketing, i.e. rapidly rising in a spectacular fashion. This is a good term to use for describing advances in sickness and accident care. Beginning with World War II and accelerating in the past two decades, spectacular advances in all fields of medical science have been achieved and are being achieved almost daily.

Much of the basis of modern medical diagnostic and treatment capacities were virtually non-existent as little as 5 years ago.

Expense is an inflammatory word. U.S. medical expenses are frequently described as a percentage of GNP and are allegedly rising more rapidly than any other component of GNP. That may or may not be true. I suspect, however, that a lot depends upon who is doing the accounting.

Value encompasses the concepts of expense, quality and effectiveness. Modern technological diagnosis and treatment is more valuable than older methods of management and frequently less painful and more humane. For example, anginal management (heart pain) with modern surgery and medications is far more valuable than the management available ~ decades ago.

In fact, two decades ago a person with severe angina was strictly disabled. Careers were over then and the loss to society both economic and social was great.

Furthermore, I doubt there are many who would advocate a return to gallbladder and kidney stone surgery when they have the options of laparoscopic gallbladder surgery and sonic kidney stone dissolution. There is no doubt that the cost of these services has increased our national outlay for sickness and accident care. But it is illogical to say modern medical care is more expensive than that of yesteryear without considering value.

It is likewise illogical to say medical costs are rising. That which was non-existent cannot rise.

Still, our society spends more of its collective wealth on sickness and accident care. I believe there are four main factors for this: more valuable surgical and medical sickness management techniques, an increase in the utilization of these services, defensive medical practice, and ~lifestyle

With respect to number two, increased utilization, it is clear that more people are alive in the United States than at anytime in history and a certain percentage of those people will become sick or have accidents. And as they live longer, they acquire degenerative disorders for which effective management exists.

Chronic conditions such as high blood pressure, coronary artery disease, diabetes, various musculoskeletal disorders including arthritis all can be managed. But it does require an expense.

Medical financing schemes which disallow market influences on purchases of S&A policies are not designed under the concept of the social need for risk reduction but rather for market needs, i.e. both economic ~and political and result in higher costs for these products. These schemes tend to enhance utilization of technology unnecessarily.

Life in the United States, for many individuals, promotes sickness and accident behavior. Poor stress management skills, poor nutrition, poor exercise habits, spiritual decay are but a few of the problems that lead to physical and emotional diseases. Furthermore, the social fabric of our country is being devastated by the deterioration of the family. This is evident in teenage high risk pregnancy, drug and alcohol dependence and addiction, family violence, and poverty.

There are many social issues which relate to impact sickness and accident costs. These must be addressed in the reformation.

The best way to decrease the cost and maintain the value of these services is to reduce utilization through the promotion of better lifestyles. Secondly, sickness and accident financing schemes need to be depoliticized through bipartisan leadership. Whatever schemes are developed should allow market forces to impact the consumer and seller, should recognize that at age 65 an individual should not automatically become a ward of the federal government, should not discourage real advancement in the science of medicine nor interfere in the art of medicine. We do not need another inquisition.

Finally, society should reconcile medical and legal practice. True negligence is neither tolerated by physicians nor by society. The natural history of disease and the vicissitudes encountered in forthright attempts to alter its course should not be just grounds for malpractice proceedings.