BE OUR GUEST

Dr. S.D. Madduri is a Poplar bluff physician. He is a previous contributor to this column.

United States has the most advanced, sophisticated and enviable health care system among the industrialized nations in the world. However, being the best has its own flaws and U.S. health care is facing a crisis that is threatening its very existence. The cost of health care in this country is soaring, and many Americans are finding it difficult to obtain much less pay for the care they need.

Every day, the U.S. spends $2 billion on health care. We spend 12 percent of our GNP on health care, the highest in the world. Britain spends 7 percent of their GNP on health care, Japan spends 5 percent and Canada 8.6 percent. Escalating at the present rate, by the year 2000, health care spending in America could hit $1.5 trillion. Astounding statistics tell the horror story of the inaccessibility of health care in this country: there are 37 million Americans without health insurance and perhaps another 30 million are underinsured. But many of the uninsured are employed about 60 percent of the uninsured and underinsured family heads are full time employees; an additional 20 percent work part-time.

Legislators, media and the public continue to blame the physicians for the raising health care costs, but the facts point elsewhere: to an aging society, costly new technology, increased access and abuse of medical care, population with penchant for self-abusive life style, raising malpractice costs and not to mention the least the cost of regulations. The cost of administering medical care is escalating at supersonic speed; in 1989 in the state of Missouri alone, $327 million were spent for health-related paperwork, which includes private insurance, Medicare and Medicaid. The fastest growing health related industry in the recent years is administration.

Is National Health the Answer?

The U.S. is the only industrialized nation besides South Africa that does not have a comprehensive national health program. Frustrated with an inability to curb escalating medical costs and provide health care to all citizens, Congress is looking toward national health care. Of course, it is strongly endorsed by the industries and labor organizations. The Canadian system of national health, which is being looked upon favorably, has a single payer, the government. The Canadian government pays about 37 percent of all health care costs and each of the 10 provinces pays the remainder. U.S. Rep. Fortney "Pete" Stark (D-Calif.) believes a single payer would mean a dramatic cut in expenses. A single payer would, of course, mean consolidation of all carriers and reimbursement plans, thus reducing the administrative costs and other procedural and marketing expenses incurred in today's pluralistic system.

Flaws in National Health Care System

Though the media and the government are painting a rosy picture, national health care is not all that effective even in countries like Canada and Great Britain. Restricted technology, long waiting lines for medical care, poor funding which is dwindling are just a few insufficiencies to name.

Canada is far behind the U.S. per capita availability of selected medical technologies. According to Project Hope's publication in 1989, there is a wide discrepancy in Canada and in U.S. in the availability of six technologies that have "wide medical applicability". They are: open heart surgery (Canada has 32 centers while U.S. has 793), organ transplantation (28 in Canada and 319 in U.S.), extracorporeal shock wave lithotripsy-stone disintegration devices (4 in Canada and 228 in U.S.) and magnetic resonance imaging (12 in Canada and 900 in U.S.).

Because of inadequate budgetary allocation, hospitals in Canada are taking beds out of service, limiting the number of operations. In Toronto an estimated 1,000 people are facing waits of as long as a year for heart bypass operations. In Ontario, the normal wait for cataract surgery is 5 to 6 months. Emergency departments in large hospitals in major Canadian cities have been shut down because of lack of beds.

At this time, health care in Canadian provinces consumes more than one third of the total provincial budget. The province of Ontario shows projected expenditures for 1989 and 1990 of close to $14 billion, on total government revenues of $40 billion. A heated debate is raging over whether of not Canada can continue to afford the 20-year old publicly funded universal system. Underfinancing and rationing have created a two-tiered health care system in Canada, where those with money go to private clinics or the United States, while those without political connections and/or financial resources wait in long queues.

Even Great Britain, the "Grand Daddy" of national health is actively looking into "privatization" or "Americanization" of the British socialized system.

The economics of implementing national health care system in the United States are staggering. The price-tag for such a system is about $600 billion annually. Excluding the funds that are already being spent on Medicare and Medicaid, the government has to raise $339 billion in additional taxes. This has to be collected either from the employers in the form of health insurance tax and from the public.

The government's one-payer system will make patients believe that they will be entitled to complete, free medical care. This will create a credit-card mentality among the American public. As in Canada, there will be unlimited demand for services with limited resources. This will create delays in diagnostic testing and therapy, particularly surgical. This will lead to more governmental regulations. Overall quality of care in the United States will decrease as costs skyrocket and physicians lose their autonomy.

American medicine is at its crossroads and a wrong turn at this crucial juncture may lead us to an unpleasant situation. Whatever the cri~tics say, the United States has the best medical care in the world and we should strive to keep it that way.