SKILLFUL NEGLECT: NATURE OUTPERFORMS NATIONAL HEALTH PLAN

A friend and physician, once asked to explain his philosophy for curing the ills of mankind, said he owed his success to two words: "skillful neglect." Pointing out that Nature was the greatest healer, the wise and witty doctor said his challenge was keeping patients alive long enough for them to be healed by natural forces. "Skillful neglect" might well describe the methodology of our elected officials in Washington as they sought to keep their "patient" alive long enough for needed health-care remedies to be enacted.

Thus far, there has been more neglect than skill shown by any of the parties involved.

It would be difficult to name any modern subject, save perhaps the Vietnam War, that has been subjected to so many observations -- and so few resolutions. Treated to untold versions of health programs, funding alternatives, mandates and non-mandates, charges and counter-charges, cute and not-so-cute television commercials and reasonable and unreasonable claims, this issue has worn out the country, not to mention the men and women we elected to resolve it.

After 18 months of headline-grabbing studies, hearings and proposals by the Clinton administration and a summer-long series of debates in the Congress, the only alternative at this moment is delay. The best course of action now is to take none. Let a refreshed president and a different Congress return to Washington in 1995 and start all over.

When that start is made, there are several points to be remembered on this vital, national-interest question, and I offer these proverbs as a reminder of past mistakes as well as future guideposts for the next round on Capitol Hill:

Proverb No. 1 is simple and not subject to challenge. It states that a solution to what ails us cannot be neglected for long. The reason is obvious: health-care needs will not go away. They must be dealt with, for the status quo is too dangerous and too costly.

Proverb No. 2 is almost as incontestable. It is the harsh fact that the illness and injury that underlie the need for health care bear almost no relation to the ability to pay for it. To a very considerable degree, health care is necessarily a social service.

Proverb No. 3 notes the need for health-care coverage to be universal. If it isn't, the uncovered segment will, in the rural language of yesteryear, fester until some kind of poultice is applied.

Proverb No. 4 notes that the overriding problem of universality is the extent of coverage not of people but of services. This addresses such vital issues as whether every sick person is to be eligible to receive the most sophisticated and expensive treatment that a physician can prescribe, even in the absence of hope of recovery. The answer, it seems to me, to this query is, unfortunately, no. Who answers this question is a very sticky problem that has not been addressed in any of the plans put forth by anyone in Washington.

Proverb No. 5 recognizes the contrast in possible approaches to a desirable medical program. No other public issue in recent memory has presented such a stark confrontation between humanitarianism on the one hand and money-grubbing on the other. The humanitarian aspect is clear enough. But there's a reluctance to admit that the act of providing health care is exceedingly profitable for a great many of those who are engaged in it.

Health-care reform has been described as being a "trillion-dollar pot of gold up for grabs." Well, there are plenty of institutions that have a stake in that pot of gold, and these include, on an annual basis of return, hospitals, with $409 billion; doctors $195 billion; nursing homes and home health care $108 billion; pharmaceutical companies $100 billion; insurers $62 billion; and all other segments, $100 billion-plus.

These costs evoke Proverb No. 6, which is that some kind of cost control is essential. Without it, costs will head for the moon and keep on going. Already, 14 percent of our gross domestic product goes to the health services industry, with higher figures just around the corner.

Proverb No. 7 deals with the all-important point of financing. Among all the ways health care can be financed, income tax deductibility is the most regressive. By this scheme, the high-income, high-tax-bracket taxpayer gets maximum funding, while the lower-income brackets are stuck with whatever the family budget can muster at the time.

Proverb No. 8 is an admission, or warning, that any health program that meets other goals will not guarantee total freedom of choice for one's physician or other provider of services. Personal relationships can be established but they will not, and cannot, be exclusive. In the final analysis, the service provided is more important than who does the providing, although the importance of the latter should also receive consideration at some point.

Finally, the last proverb is more a prediction than irrefutable fact, namely that someday, after trial runs of this or that convoluted plan, the single-payer course will be taken. It is quite possibly inevitable that we will do so not because we like the Canadian system so much but because anything else we have tried will have bogged down in its own complexity. We are trying too hard to appease too many interest groups, and pursue too many goals, while overlooking the central need.

It is probably true that whatever plan is devised will be financed by a tax. In this regard, it's well to ask how much difference is there between a tax and the present mix of tax-revenue funding, business levies, insurance premiums and patients' delinquent medical bills? A dedicated tax would be less expensive, and more efficient, in the long run.

Jack Stapleton is a veteran journalist from Kennett.