TIME: Almanac 1993/TIME Almanac 1993.iso/time/050790/0507350.000

Text File | 1992-08-28 | 6.5 KB | 137 lines

                                                                                MEDICINE, Page 50

A Call for Radical Surgery


A major doctors' group joins the drive to overhaul health care


    If the U.S. health-care system were laid out on the
operating table, its condition would be rated critical and
worsening. Though the country has physicians with unsurpassed
training, its health-care delivery is among the most expensive,
least efficient and least equitable in the developed world. Of
the industrialized nations, the U.S. ranks 17th in life
expectancy and an appalling 20th in preventing infant mortality.
Yet the prospect of a national health-insurance system, long
advocated as a solution, alarms many doctors. They see it as an
intrusion by Big Government into their professional lives --
and, perhaps more important, as a threat to their high incomes.

    So it came as a shock last week when the American College
of Physicians, the U.S.'s second largest medical society, called
for comprehensive health-care reform that would include some
form of national financing. The announcement, made in Chicago
at the A.C.P.'s annual meeting, marks the first time that a
doctors' group has backed an overhaul of American medical care.
And it puts the 68,000-member group at direct odds with the
powerful 300,000-member American Medical Association, which has
been opposing sweeping change for at least 30 years. Says Dr.
John Ball, the A.C.P.'s executive vice president: "We hope to
produce some leadership for the medical community."

    Somebody has to do it. Medical costs have soared from $75
billion in 1970 to $600 billion last year, gobbling up more than
10% of the gross national product. And while many citizens
receive exemplary care, many others -- mostly poor women and
children, and the unemployed -- do not. About 50 million
Americans have inadequate medical insurance, and as many as 37
million have none at all.

    Among the solutions offered by the A.M.A.: force more
employers to provide health insurance, and expand Medicaid
coverage for the poor. But the A.C.P. labels such changes
"tinkering," not reform -- helpful in the short run but
inadequate to address the fundamental flaws in the system. In
the 21-page position paper it issued last week, the group cites
several such flaws, including wasteful administrative overhead
that has burgeoned to 22% of medical expenses, and enormous
malpractice awards that force doctors to buy expensive
insurance and pass the cost on to patients. But the biggest
problems, according to the A.C.P., are inadequate care for many
Americans, and the "complex, confusing, costly, wasteful and
intrusive" bureaucracy involved in paying for the care others
get.

    Instead of suggesting specific answers to these and other
problems, the A.C.P. offers broad guidelines. Explains Ball:
"One of the reasons we don't have solutions today is that we
haven't got societal agreement on what kind of health system we
need, want and can afford." Although the report does not say so
explicitly, the Canadian health-care system, based on principles
of accessibility, universality and public funding, is a model.
The reason Canada was not mentioned, according to one official:
its system is considered by some to be "socialized medicine," a
buzz word that could torpedo the reform effort. Besides, says
Ball, the Canadian model could not be wholly transplanted into
the U.S. because, among other reasons, Canadians trust their
government more than Americans do.

    Still, the Canadian system has a good deal going for it.
Citizens are issued a health card by the government, and they
present it when they receive care. Doctors process claims much
as retailers handle credit-card transactions. The government
then pays the doctor with money that comes largely from taxes.
"Once somebody's in the system," says Dr. Graham Pineo, an
A.C.P. officer from Canada, "the payments flow regularly." Only
a few services are excluded. Among them: private or semiprivate
hospital rooms, drugs prescribed outside the hospital,
eyeglasses and wheelchairs, and pre-employment and insurance
examinations.

    Provincial governments have ultimate control over hospital
budgets and doctors' fees, but in return do not force physicians
to justify every procedure and test, as U.S. doctors must do.
And while there are occasional reports of long lines and
insufficient bed space, Pineo says, "we feel everybody gets
adequate service."

    The A.M.A. predictably has pooh-poohed the A.C.P. statement.
Says Dr. Raymond Scalettar, an A.M.A. trustee: "It contributes
very little to the debate. The American health-care system needs
to be improved, but it works." That reaction may say as much
about medical politics as about medical policy. Until recently
the A.M.A. dominated the field. Now it is being challenged. Says
Ball: "Other medical groups still believe in the politics of the
past. That's when medicine could demand its way. The politics
of the present and the future is when medicine and other
elements of society sit down equally to solve a societal
problem."

    The A.C.P. is hoping to build a coalition of industry
leaders, politicians, health-care-provider organizations and
consumer groups that might build a consensus for dramatic
change. The group is already working with AT&T and the United
Auto Workers, and in recent weeks it has presented its proposals
to the American Association of Retired Persons.

    That is no substitute for leadership from the most effective
lobby in the nation -- the White House -- but it looks as though
the characteristically cautious Administration will not provide
it. Health and Human Services Secretary Dr. Louis Sullivan told
the A.C.P. last week that he found its proposal "thoughtful and
thoroughgoing" but that "a simple national system will not meet
the needs of such a diverse group of people."


By Anastasia Toufexis. Reported by Barbara Dolan/Chicago.


____________________________________________________________

                                      U.S.    Canada   Britain

Annaul health costs per capita      $1,926    $1,370      $711

Health costs as a % of GNP            11.1%      85.%      6.2%

Life expectancy                         75        77        75

Infant mortality, deaths per 1,000
 births                                 11         7         9

% of population not covered by health
 insurance                              14%         0         0