There should have been another surgeon general's warning that said, "Beware -- the health system of this country could be dangerous to your health," Dr. C. Everett Koop, the outspoken former surgeon general, told a Baltimore-area audience of several hundred today.
"We are in real trouble, there is no doubt about it," he said during the keynote address at the 25th anniversary medical conference held in a tent outside the main entrance of the Greater Baltimore Medical Center in Towson.
"There is no single magic bullet to fix it, no panacea, just hard choices."
The answer to the multifaceted problems of America's health-care system lies in the establishment of a commission "of the right type," said Koop, who termed the nation's health care system in a "crisis."
The commission would not seek a panacea, but would "elucidate the problems, deal with them piecemeal and within a decade bring about some improvements," he said in a 75-minute talk on "The State of America's Health Care System."
The "right type" of commission has to include doctors, insurance people and Republican and Democratic members of both houses of Congress, who would be required to attend meetings and not send representatives.
"That's how we got Social Security," he said.
Koop said he would like to see the kind of national health insurance that would, among other things, provide access to basic care for the nation's 2.5 million uninsurables -- those who can't buy insurance because they are considered bad risks but still have serious health problems that need attention.
"We need to talk about the basic right of health care for all our citizens," he said.
Koop warned that the nation will never really solve its health-care problems and its insurance problems until it deals "with a deeper cause."
He said, "American health problems stem from disease not only of the body but also a disease of society, especially one major disease, which is poverty."
Poverty lies at the root of most of the nation's public health problems -- drug abuse, AIDS, alcohol abuse, malnutrition, smoking and communicable disease -- and the effects of poverty on health care can also linger for a long time, he said.
A recent study, he said, found that middle-class blacks with a college education were twice as likely to deliver low-birth-weight babies than whites of similar education and income. The researchers concluded, he said, that the effects of poverty as demonstrated in low-birth-weight babies "could last for generations."
Koop provided some sobering statistics:
One in three urban kids lives in poverty today. Every day in America, 100 children die before their first birthday. In Harlem, the infant mortality rate is worse than in many places in the Third World. A staggering one in five babies has been exposed to drugs in the womb and 5 percent tests positive for the AIDS virus.
A total of 400,000 drug-exposed babies were born in the Unites States in 1989 and the neonatal units that care for them cost $4 billion annually. In overcrowded public clinics in the inner cities, the average wait is 60 days for an appointment.