MISSOURI WATCH: REMEMBERING HST's ADVICE -- SOME 46 YEARS LATER

Most Americans who heard the president of the United States, then engaged in a campaign to win a full four-year term in the White House, propose a national health care insurance plan were highly skeptical. Speaking at whistle stops all across the country, Harry Truman told listeners that too many of them were being denied adequate medical care because they couldn't afford it, and then he would add his typical HST kicker: "The reason America is being denied this care is because a do-nothing Congress has failed to act on my proposal for national health insurance." Actually the plans hadn't yet been formulated, since the White House staff had decided not to go through the motions of specificity unless their chief was returned by the voters.

That was 1948, and it was the first presidential election since the end of World War II, so the nation was bustling with economic energy, even though it would soon slip into an unexplained recession. The idea of a national health care system was foreign to most of us, and the only real knowledge we possessed came from watching its introduction in Great Britain, where the cries of anguish made it seem the worst idea of the century. The Brits didn't like their "socialized" system, and their complaints made us believe we wouldn't be any more enthusiastic. Besides, we had already heard our own family doctors pledge they would give up their practice if forced to participate in "Truman's Folly," which was the name the American Medical Association assigned to national health care.

Mr. Truman didn't win many friends with his health care advocacy, even if he did win the 1948 election. True to his word (a now uncommon phrase when applied to national leaders) the newly inaugurated chief executive sent a national health insurance proposal to Capitol Hill, where it was received with all the enthusiasm only a small minority of supporters could muster. Mr. Truman barely had the support of the Democratic leadership in Congress, and if he had any more than a handful of votes it was never evident during any of the subsequent debates.

The cost of the president's plan was shocking to everyone who heard it. A billion dollars! The obvious response was that America couldn't afford such an expensive undertaking. It would surely bankrupt the nation, which most of us agreed was doing all right without Mr. Truman's proposals. I remember writing an editorial in the college newspaper, using facts

had secured from the dean of the medical school. I recall no memorable sentences in the editorial, only the declarations that HST's plan was "socialism" and that Americans would prefer to buy their own health care from their physician-of-choice.

I've thought about Mr. Truman's health care plan and my editorial a great many times in recent years, wishing I had been more attentive to what the president was saying and more open to his suggestions. But the times were different, and so were we all.

It accomplishes nothing to wish that Mr. Truman's plan had received greater public support nearly half a century ago. With or without the plan, we now find ourselves in a different world, where billions have replaced millions as cost figures and where HMOs have replaced family doctors who used to charge $2 for office visits and $5 for house calls. We now have free medical programs for the poor, and the doctors who opposed this plan have been laughing all the way to the bank for more than a decade. We now have nearly free medical programs for the elderly, and new medical-hospital dynasties proudly announce profits that equal or surpass the bottom lines of blue-chip corporations. The doctors who once opposed HST's program because they said it was "socialized medicine" are now working as salaried employees for giant hospital companies, charging office-visit fees that frequently equal the cost of having a baby a generation ago.

These conditions, which Mr. Truman sought to prevent through his plan for national health insurance, have predictably worsened over time, and few Americans believe we can continue paying for them and remain solvent. The Republicans are stuck with supplying the answers to a health system that is driving us to the financial wall, and no one in his right mind envies them their thankless assignment. Cutting costs of systems that have been allowed to grow by political whim, that have served to enrich the profits of delivery systems and which have ignored obvious cost-cutting solutions is an unpleasant and unpopular assignment that will wind up suiting no one.

We might want to take at least a couple of codicils from the Truman proposal and use them today, although we could have taken the entire package and escaped our current dilemmas.

The president proposed in 1949 that national health care be extended on a gradual basis, with those needing it the most being covered first. This would assure an orderly process of meeting emergency needs, while providing experience in handling later population segments. He called then for inclusion of the very young and the elderly, and when this process was completed, all citizens were to be covered.

It is probably impractical to follow this pattern today, but the speedy rush to evolve the entire health-medical field at once suggests an invitation to confusion, disorder and far too many mistakes. We're already seeing this in our own state, where Medicaid recipients are being placed in HMOs with little regard for the type or quality of care required. The result is that treatment is being denied because regulations do not cover the specific needs of critical patients. Further harm is likely to be incurred by the mentally retarded, whose specialized needs call for careful placement and specific care.

Avoiding the kind of knee- jerk political opposition they provided the Truman proposal, Republicans need, and indeed must have, bipartisan support from Democrats in Washington. There is no politically correct way to administer health care delivery systems, although both parties would have us believe otherwise. If we had only heeded this advice in 1949, we would surely have escaped the problems we now face in 1995.

It would not be surprising if HST is looking down at us at this moment and saying, "Damnit, I told you so!"

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