A national scandal

April 05, 1991

An interesting bit of history was played out this week at the Johns Hopkins School of Hygiene and Public Health. The institution was established in 1916 as the first public health school in America, with a grant of $267,000 from John D. Rockefeller Jr., who came to Baltimore to deliver the check. Last Tuesday John D. Rockefeller IV -- the benefactor's grandson and now a U.S. senator from West Virginia -- came in his famous forbear's footsteps to deliver the annual J. Douglas Colman lecture at the school -- and a sharp lecture it was.

Although the two men are two generations removed, their hope is strikingly similar. Almost by definition, public health is preventive medicine on a grand scale and that was old John D. Rockefeller's purpose in endowing the school. Sen. Jay Rockefeller is preaching the same message in a slightly different form: Government must immediately take the steps to guarantee access to medical treatment for all Americans in a time when at least 34 million Americans, most of them the working poor, are uninsured. The result of this shameful statistic is that the hospital emergency room has virtually become the family physician for those people.

This results in an immensely inefficient use of medical resources -- the unnecessary expenditure of huge amounts of money for treating conditions which could have been prevented at only a fraction of the cost had the people had access to medical treatment when their symptoms first appeared. Fully half the patients at Hopkins Hospital at any given moment are being treated for conditions that could have been prevented.

Rockefeller is not naive; he knows that even though America shares the ignominy of South Africa in being the only industrial nations which do not have universal health care as a matter of policy, we cannot in the foreseeable future attain the $222 billion annual expenditure needed to establish Canada-style national health insurance. But he does believe that we can attain the $24 billion annual expenditure which could guarantee universal access to health care -- chiefly by providing incentives to small employers who cannot afford adequate group insurance for their employees.

But even that, he ruefully notes, is in doubt because of the lack of any meaningful effort by the White House.

"Children without health care is just not tolerable," Rockefeller said, his voice rising in indignation. But that's exactly what we have come to -- we tolerate the intolerable. And we will continue to tolerate the intolerable until the public demand forces the White House to address this national scandal.

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