HEALTH CARE: COSTS OUTSTRIP GENIUS OR INFINITE NEEDS VERSUS FINITE COSTS

In 1969, during my first year as a U.S. Senator, I gave a speech at the Washington University School of Medicine about health care costs. I searched my files and dug out a copy. In that speech I expressed "serious concern" that health care costs were 7 percent of our Gross Domestic Product. I spoke at the school again on the same topic in 1980 when health care costs were 9.1 percent of GDP. I expressed "grave concern." I spoke there last week on the same topic, and health care costs are now 12 percent of GDP. This time I voiced "alarm and grave concern." Health care is the fastest rising sector of the American economy.

The New York Times has been running an extensive front-page series entitled "The Price of Health." It deserves to be a front-page story. Americans, generally speaking, like their doctors and think they are getting proper care in their hospitable, but there is enormous anxiety about the future as health costs soar.

The quality of American medicine is the best on earth, but access and distribution are severely uneven. The uninsured inner city (13 percent of the population), and the back-water rural poor are as in every other facet of American life almost totally excluded from the system. As health care evolves into a political right rather than a privilege, the gap between the well served and those left out will tend more to be a central campaign issue. This result will be an additional upward push on health care costs.

Western Europe and Canada have national health programs. The quality of medicine at the high and of the governmentally supported system is in no way comparable to the quality of medicine offered at the high end of our private system. No argument about that. However, the total range of coverage to all people under all circumstances is better than what is currently available at the low and of our system. No argument about that either.

Canada spends $1,400 per person on health care. Britain spends $700. In the United States it's $1,800. The vast number of Americans covered by private health insurance (60 percent of the population) will not be willing to make do with less. They will not accept long waiting periods for medical services or out-of-date technology.

The PET scan, one of the newest emerging technologies, is used to evaluate heart tissue. A scant 50 U.S. hospitals have one and soon the PET scan will be the hallmark of quality. A hospital won't be first-rate without one. They are $5 million a pop and each examination scan costs $2,500. Wouldn't you want your cardiologist to use it if he thought it might help in your open-heart surgery? In the United States, scientific and technological research is so advanced and progresses so rapidly that we may be inventing ourselves out of the health business. Our genius in developing machines and tests may outstrip our ability to pay for them. Infinite needs have run into finite sources.

As of now, the political pressures encourage sticking with the status quo. Ultimately, the pressure for a national medical system will come from employers, large and small, as the health care component of their corporate budget continues to spiral. Business will want medical costs off their books. The day will come perhaps in the next century when the U.S. Chamber of Commerce will lead the nation into "socialized medicine."