OF BREAD AND BANDAGES AND BALANCING OF BOTH

Missourians now spend more for health care than food. Although this statistic became reality only a short time ago, it is really not surprising to Missouri employers, wage earners, farmers, fathers and mothers and anyone else trying to get along in today's world. Everyone, it seems, talks about the need for affordable health care, but no one in Jefferson City or Washington seems able to do anything about it. The awful truth is that the nation's health system is unable to cope with the demands of consumers (patients), escalating costs, inflation and, yes, the increasing life span of all of us.

Despite a baker's dozen of health plans introduced in the Missouri General Assembly and the national Congress, no one seems capable of overcoming irrefutable facts: more and more families have no health insurance, our state's private and public hospitals are facing financial difficulties that will force an alarming number to close their doors again this year, and the high costs of employee health coverage weigh heavily against the ability of U.S. companies to remain competitive in today's markets.

Just about everyone is discussing the subject. In this year's session of the Missouri General Assembly, 55 bills dealing with medical and health insurance were introduced, and exactly three, all dealing with relatively minor subjects, were enacted. Congress has debated health care for so long the subject has a life of its own. Next month's National Governors' conference will highlight health care and insurance, but if anything results it will be a modern medical miracle.

An Associated Press story the other day, quoting Health and Human Services Secretary Louis Sullivan, cited the most recent statistic on health care: it now amounts of 12 percent of America's Gross National Product. Dr. Sullivan warned the physicians he was addressing that medical costs are rising so fact, partly because of the actions of his audience, that federal intervention was not only possible but probable. About all the country's health system would need to make it terminal would be the appearance of Super Manager Uncle Sam.

Thirty-seven million men, women and children are now without health coverage. The average cost to employers for insurance per employee increased 15 percent in 1990 to around $3,000. General Motors is spending $3 million a day, that's more than $1 billion a year, to provide health care for its more than 281,000 employees. Health care costs now add about $660 to the cost of every car, truck and van built in the United States. Moreover, 39 percent of all business profits now go for employee health insurance costs, and this number could reach 60 percent by the year 2000.

The 12 percent figure Dr. Sullivan cited for health costs sounds familiar, since it matches the U.S. Department of Agriculture statistics showing that consumers now spend 12 percent of their disposable income for food. But the two figures are not really equal. Sullivan's 12 percent for health spending is calculated from Gross National Product, while the USDA's 12 percent for food is from disposable personal income. The latter is the smaller base, which means spending for food now lags considerable behind health care expenditures.

Gross data are not of themselves a convincing moral judgment because the numbers are a statistical jungle. For example, the health spending total does not include the costs of all nursing home care, but there is no mistaking that total annual health care costs are not about $2,500 for every man, woman and child in the country. On the other hand, the USDA reports spending for food at just above $500 billion annually, or $2,000 per capita. Since disposable personal income now runs at just under $16,000 per capita, food spending is indeed around 12 percent.

Physicians who heard Dr. Sullivan warn that high medical costs invite a demand for "a total government takeover of health care" were understandably upset. Many undoubtedly believe they are worth more than their average annual income of $150,000. At the other end of the scale, farmers have always been equivocal about the statistic of how little of their income consumers spend for food. Many believe the data reveal how badly America's food producers are treated.

It would not be correct to say the two trends for bread and bandages reflect only "natural economic forces." The health care sector is a fortress of built-in subsidies and guild rules, whole agriculture and the food system have their own institutional features. "Health care," Dr. Sullivan told his physician audience, "is not the only public good, and consuming ever larger portions of GNP necessarily diverts resources from other good uses." And he's absolutely correct.

Providing for a reasonable balance between America's health sector and the nation's food system is an appropriate part of national economic policy. Caution should be sounded about continued trends in opposite directions.