STATE MUST FACE UNMET HEALTH CARE NEEDS

As legislators close down their offices in the state Capitol and return home where many of them face pitched political battles in this year's primary and general elections, the one issue they were unable to confront to any appreciable degree was Missouri's health care crisis.

Several proposals to inaugurate state-sponsored medical and hospital programs were voted down in the session just ended, not because lawmakers were indifferent to the growing needs of their constituents but because there was not an extra dollar to finance programs other than those already in effect.

The lack of progress was not because there are no legislators interested and concerned about the growing health care gap in Missouri. There are numerous lawmakers who have worked extremely hard to secure passage of various proposed remedies, including a broadly based program that has been sponsored in recent years by state Rep. Gail Chatfield, one of the state's most knowledgeable officials on public medical plans. Rep. Chatfield's health care proposal has continued to gain support since it was first introduced, but the absence of anything more than loose change in the state treasury has prevented serious consideration of the St. Louis Democrat's program.

Thus legislators shut down this year's session without making any real progress toward meeting health care needs that closely resemble an emergency of the first order. In this respect, Missouri's General Assembly is not unlike the federal Congress, which also has found itself thwarted in meeting critical health care demands by an absence of available revenue. Indeed, the crisis that is rapidly growing throughout the nation is bound to impact on Missouri's ability to come to grips with improving the health of its citizens. No one can doubt that the United States does, in this summer of 1992, face a health care crisis that is not only growing worse but, perhaps even more importantly, cannot be funded because of escalating costs of programs already in effect.

Contrary to what you might have heard, federal funding of programs for the poor has increased in the past four years. The Congressional Budget Office has just reported that spending on programs for the poor has increased $70 billion in the past year alone, and over the past three years has increased more than twice this figure. The problem is not that Washington has reduced welfare spending but that much of the increase has gone to persons other than intended recipients. For example, two-thirds of the increase in Medicaid spending has gone to doctors, hospitals, nursing homes and drug companies.

Furthermore, federal Medicaid spending which buys health care for the poor and disabled now accounts for nearly 50 cents of every dollar Washington lays out for poverty programs. Ten years ago, the figure was 30 cents.

No one should have any doubt concerning the federal government's investment in health care. Spending on Medicaid, Medicare for the elderly and health insurance for government employees took 10 percent of the federal budget in 1980. Today these programs take 15 percent of all federal spending. Ten years from now, according to the Congressional Budget Office, the percentage will be 28 percent or in other words, nearly twice what it takes now to finance these programs.

It is both safe and accurate to say that health care spending is rising far more rapidly than the health of Americans is improving. As witness the growing infant mortality rates in Missouri, which we have discussed in recent columns, and which, if allowed to continue, will eventually place the poor children of our state in greater jeopardy than those in Bangladesh.

According to the experts with whom we've talked, Medicaid isn't the basic cause of the problem. As a matter of fact, despite the bad mouthing Medicaid receives from politicians and those who prefer to retain the status quo, Medicaid pays health care costs that other insurers (both public and private) won't pay: nursing home costs, care for AIDS victims, mental illness and drug addiction treatment and a variety of other ailments. Medicaid is only a small part of Uncle Sam's spending for health care, and as anyone can observe, Washington spends far more on care for people who aren't poor than those who are.

This growing crunch of demand and public penury will, if not corrected, force states such as ours to cancel existing programs. This last session of the Legislature appropriated fewer dollars from general revenue for social services than did the session last year. Sooner or later, we must all face this crisis of unmet health care needs in our state and nation.