MISSOURI WATCH: HEALTH CARE MAY MAKE YOU ILL

Warning: The following information may be detrimental to your health.

America has long taken great pride in the accomplishments of what we choose to call "medical science." Researchers, surgeons, family physicians and just about every one connected with health services have been viewed as a team that provided millions of citizens with modern, up-to-date and caring medical services that have over the years saved lives, made living easier and more comfortable and gradually reduced the danger of serious, communicable diseases.

Fortunately modern medicine has become more technically advanced than ever before, reaching more and more families with a rapidly increased corps of highly trained professionals. Indeed, modern medicine is recognized as one of the great benchmarks of our technological age. That's the good news.

The bad news is that the system for delivering these modern miracles is becoming a monster. An untamed one at that.

Although at one time the medical delivery system remained the responsibility of and within the purview of a medically driven professional corps, the federal government became an integral part of this force with the creation of tax-supported health programs designed to meet specific needs within society. Medicare and Medicaid programs are good examples, although there are now others, in one form or another. With the injection of public money into previously private programs, both the creation and administration of health care have come under the sometimes indirect and often direct control of our political system.

It may be philosophically difficult to imagine Bill Clinton or Newt Gingrich or Mel Carnahan creating programs that would harness the entire medical profession to specific standards, but from a practical standpoint, this is exactly what has occurred over the past quarter of a century.

As a result of the political nose under the medical tent, Missouri and every other state now wrestle with methods to combine both public and private plans to create an acceptable delivery system. It is fair to say that the Missouri Department of Social Services probably exerts more control over the medical care of more Missourians than the rest of the state's medical professions. It certainly exerts virtually total control at this moment over the medical care received by Missourians enrolled in the Medicaid system, and this complete authority influences to a large unrecognizable degree indirect control over private physicians, hospitals and other care providers.

During this year's session Missouri's General Assembly will attempt to correct some of the deficiencies that have arisen from medical groups known as health maintenance organizations, and whether these political attempts succeed or fail will, to a very large degree, affect the kind of attention your next illness or disease receives.

Extension specialists at the University of Missouri have been keeping a close watch over the evolution, some might choose to call it a revolution, of health care in both urban and rural areas. HMOs are not only a reality in urban areas, they have become the dominate force, along with the rapid centralization of hospital services into fewer and fewer hands. University specialists, noting fewer HMOs in outstate Missouri, state unequivocally that if rural communities want to retain and control their health care services, active and aggressive community leadership will be required. This is especially true if so-called corporate managed care interests decide to use their capacity to thwart politically accountable solutions. As a matter of fact, corporate interests are noticeable throughout the state as they press forward at full speed to economize medical services ahead of effective public resistance.

Whether an urbanite or a country dweller, the average Missourian has cause for concern about the future of health care in his neighborhood, community and county. The shift of Medicaid services from Washington to Jefferson City creates even more concern over the advent of corporate systems that are anxious to serve on an exclusive basis not only privately insured patients but those who rely on publicly funded programs.

The magic phrase today is managed care, a catchword that implies an elevated goal for health care policy. Corporate groups claim they provide it. There is some evidence they do not, at least without a reduction of care. Indeed, the distinction between managed care and managed costs may epitomize the reasons why health care issues remain so troublesome.

Like its counterpart in agriculture or retailing or manufacturing, corporate medicine offers advantages as well as liabilities. In the case of health care, there is an argument that efficiently operated units can provide medical care to communities and outstate regions that have sometimes even lacked minimal service units because of their location or lack of opportunity for private physicians and delivery systems. There are scores of rural Missouri communities that sought, often vainly, to attract physicians to their small towns, offering such perks as publicly owned clinics and other inducements.

It is quite possible that corporate medicine can provide additional services to these regions and their sizable populations, and this has to count as a positive feature.

The other side of the coin, however, is that physicians who become hourly workers for huge management groups can lose much of the dedication that so typified earlier professionals in Missouri. Even medium-sized cities can still fondly recall physicians from an earlier generation who not only knew and cared about their patients but, heaven forbid, occasionally treated patients in their own homes.

Hospitals have a different feel about them if corporate managers located in a remote office suite opt to recover capital costs through computerized delivery systems. One is reminded of modern packing plants that process their products by way of moving meat hooks. Efficient, yes. Humane, hardly.

The problem is the average outstate Missouri patient won't have a choice in deciding the system he is provided.

~Jack Stapleton of Kennett is the editor Missouri News and Editorial Service.