Sen. John D. Rockefeller IV, the West Virginia Democrat who is emerging as the leading congressional spokesman on health care matters, was in a sentimental mood when he recently visited the Johns Hopkins School of Hygiene and Public Health.
This was, after all, the school which his famous grandfather had bankrolled 75 years ago to the tune of $267,000 -- a handsome sum indeed for the time.
But instead of bringing money, Mr. Rockefeller could only bring a sober warning: "We have got to do something immediately to stop the explosion of health care costs in the United States."
And he is keenly aware that what must be done cannot be addressed with private wealth, because not even the fabled fortune of the Rockefellers could make a dent in the need.
Rather, Mr. Rockefeller, as chairman of the Bipartisan Commission on Comprehensive Health Care -- renamed the Pepper Commission for the longtime congressional champion of health services, the late Claude Pepper of Florida -- proposes the relatively small expenditure of $24 billion a year in public funds to guarantee access to health care to all -- not health care itself, but merely access.
As a realist, Mr. Rockefeller knows that is the most he can hope to achieve in a time of severe fiscal constraints which are the legacy of the Reagan presidency.
Today Americans are spending $765 billion a year on health care. That's 11 percent of the Gross National Product, which is nearly double the GNP share devoted to health care just 25 years ago.
But as large as that figure is, says Mr. Rockefeller, it represents just the tip of a social and fiscal iceberg. If health-care costs continue to escalate at the current rate of more than 10 percent per year -- which is more than double the general rate of inflation -- the annual cost by the turn of the century will be $1.8 trillion.
To get a perspective on the breathtaking magnitude of that figure, that is nearly half a trillion more than the current national budget in its entirety; it is slightly more than Ronald Reagan spent on national defense during all of his eight years as president; and it represents roughly a quarter of the projected Gross National Product at the turn of the century.
And yet, the senator went on, despite the enormity of the expenditure, the United States remains the only developed nation in the world, except for South Africa, which does not have universal health care as a matter of public policy.
In fact, 34 million Americans, most of whom work in small businesses, are without any health care coverage at all -- neither private health insurance nor Medicaid.
Another 20 million of the working poor are underinsured, so that a single illness can plunge them into financial ruin.
Together, that constitutes more than a fifth of the nation's population. Moreover, nine million of the uninsured are children, which is a truly scandalous situation.
And it is precisely because of this huge gap in medical insurance coverage that the American health care system is so inefficient, Mr. Rockefeller contends.
For the millions of Americans who simply do not go to the doctor when the first signs of illness appear, he said, "the emergency room has become the family physician." As if to underscore that observation, a doctor responding to Mr. Rockefeller's remarks noted that roughly half the beds at Johns Hopkins Hospital at any given moment are occupied by people suffering from illnesses which could have been prevented.
In a sense, Mr. Rockefeller's proposal to spend $24 billion a year -- largely in a carrot-and-stick approach to help small businesses provide adequate private health insurance -- is in itself little more than a preventive measure.
To provide national health insurance along the Canadian model would cost between $222 billion and $324 billion a year. The senator is enough of a realist to know that in the present climate this is an unattainable goal.
But, Mr. Rockefeller lamented, even the $24 billion proposal to guarantee just access to health care remains dead in the water because "we're getting no help out of the White House whatsoever -- and you can't get anything done in this town [Washington] without the help of the president."
Meanwhile, the "explosion" continues, and we draw nearer to the time when Americans will be spending a quarter of all the wealth on health care -- and very inefficiently, at that.
Ray Jenkins is editor of the editorial pages of The Evening Sun.