Health Care: Beyond Bromides

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Sophocles wrote of an archer named Philoctetes, who was bitten by a serpent and whose wound would not heal. His countrymen were so discomforted by his injury and his anguished cries that they marooned the war hero on a desolate island. That is one way to deal with the suffering: remove them from sight. There are many like Philoctetes in America, citizens cast out from public consciousness because their medical problems seem too painful or costly to face. Among them: 37 million Americans who have no health insurance, a million young women too poor to provide adequate prenatal care for their unborn children, countless drug addicts turned away from treatment centers for lack of room, 73,000 victims of AIDS denied protection from discrimination.

Some policy analysts argue that, with an estimated $150 billion deficit this year, the U.S. cannot afford to tend to such people. But the truest index of a society is how it provides for its most vulnerable members. At stake is America's self-respect, the sense of community that binds it together, and its standing in the community of civilized nations.

The next President should make a priority of health, particularly the fair distribution of health services. With the notable exception of Surgeon General C. Everett Koop's commitment, this Administration has often gone no further in health care than bromides. Candidates George Bush and Michael Dukakis declare that health care is high on their agendas, but neither one has offered a comprehensive approach to the issue.

This year's enactment of catastrophic health insurance, the most dramatic expansion of Medicare since its inception, demonstrated that Washington can still respond creatively to a problem without busting the budget. There is a rightful consensus that expansion of the nation's health-care system must largely pay for itself; catastrophic health insurance will be paid for by premiums from those who stand to benefit. The program shows what commitment and ingenuity can produce, with the right leadership.

The first step in medical reform must be cost containment. Americans spent half a trillion public and private dollars on health care last year. Costs are skyrocketing at a yearly rate of 8.5%, more than double that of inflation and faster than in any other segment of the federal budget. By 1990 health-care costs will consume more than 12% of the nation's GNP, further draining resources from defense, education and other vital federal programs. President Bush or President Dukakis will be greeted his first year in office with a Medicare bill of $101 billion. By the end of his first term, it will be $164 billion. By the end of his second term, a dizzying $250 billion.