THE PUBLIC MIND: DOES TWO-TIER SYSTEM OF MEDICAL CARE IN UNITED STATES WORK?

To the Editor:

Health care in the United States is at its cross roads. We have the most enviable medical care system that is rated as the best in the world. At the same time, the system is costing too much and excluding too many people. A Gallop poll last year showed 91 percent of Americans believe the nation is facing health care crisis. The national debate on health care is the number one domestic issue during the last presidential election.

In 1992, a staggering $817 billion or $2,350 per person - 14 percent of gross national product - was spent on U.S. health care. That is a larger percentage than any other industrialized country. By the year 2000, just 8 years from now, the national health bill is expected to more than double to $1.6 trillion! That is about $9,400 for every family!

However, about 36 million Americans, roughly 14 percent of the population, are uninsured or underinsured and cannot afford medical care. Contrary to public opinion, those without coverage are not the very poor and welfare recipients, but lower middle-class and working class people with jobs.

The major objectives of any type of health care reform should include:

1. The care should be available to all, rich and poor alike,

2. The cost of health care should be affordable and,

3. The cost containment efforts should not erode the quality of care for which the United States is proud of.

Though the Canadian health care system is viewed favorably by many as it provides universal access, the flaws are many and may not be acceptable to American public. It is a glorified example of `rationed' health care, with long waiting lines for elective surgical procedures and often leaves no physician choice for the patients. The fact that wealthy Canadians that can afford, go to the United States for their medical care speaks beyond doubt that Canadian system has inherent deficiencies.

The notion of multi-tiered health care system predictably may offend some segments of our society as discriminatory. Some can argue that two-tier system again may cater to the rich and leave off the poor and the disadvantaged. However, I do not think it is true. If one analyzes the facts with an open mind, it could be a very viable and practical option to mend our health care system.

Two-tier system does not mean the uninsured and indigent should necessarily go to state or charity hospitals, nor does it mean that they receive substandard care. All private and for-profit hospitals should allocate certain number of `service' beds for patients without insurance and who cannot afford, where they can get basic medical care. This should not be optional, so all hospitals share the burden. The hospitals in turn will receive tax incentives for providing these services. The medical care provided should not be completely free to these patients, but the hospitals should be allowed to charge their `service' patients a sliding scale fee depending upon the patients financial capabilities. `Totally free medical care' concept will create a credit card mentality in the receiving public and there will be an uncontrollable misuse and abuse of the system.

Professional services will be provided in a similar fashion. Primary care physicians and specialists will assume the responsibility of the uninsured on a rotation basis as it is being done at present at many emergency rooms. The physicians in turn will receive tax incentives for their `charity' work and will be allowed to charge professional fee depending on the sliding scale basis.

People with low incomes should be able to buy into the government insurance system like Medicaid. In Germany, government-sponsored health insurance is mandatory to all its citizens like the automobile insurance. When everyone who owns a car can buy an auto insurance, buying into health care should not be a problem provided it is affordably available.

However, this alone will not cut down the escalating costs of health care. Careful analysis of the facts responsible for the raising health care costs in U.S. point to multiple areas: Aging society, very expensive and high tech medicine, increased access and abuse of medical care, population with unhealthy lifestyles (including improper diet, cigarette smoking, alcohol, drugs etc.), raising malpractice costs and not to mention the least cost of government regulations. Legislators, if interested in controlling the costs, should look into all these factors and try to curb them.

Health care professionals and institutions are prepared to do their fair share to bring the American medical care back on to the right tracks. We also need sacrifices from the public, the government and all other elements concerned. Two-tier medical system exemplifies the above fact.

Dr. S.D. Madduri

Poplar Bluff