'No longer acceptable'

May 15, 1991

This week's call by the Journal of the American Medical Association for a massive overhaul of the health care delivery mechanism in America represents a most remarkable turnabout by the medical community. For the first time in history the AMA is committed to a plan which would in effect guarantee access by all Americans to health care as a matter of right.

A little over 25 years ago a tacit compact was reached, under which it was agreed that the government would pay for the medical care of the poor and the elderly, while all others would rely upon private health insurance for that care.

The AMA Journal now concedes that the compact has broken down and the system has gone hopelessly off track, with at least 33 million working-poor Americans and their families without any access to medical care at all. This, declares the AMA Journal, is "no longer acceptable morally, ethically or economically."

Nothing could more dramatically illustrate the seriousness of the problem than the graph elsewhere on this page showing the staggering costs of health care in America. The percent of the gross national product being spent in this country on health care has doubled since 1965 so that today fully 12 percent of GNP is being spent on that necessity, and terribly inefficiently and discriminatorily at that.

Moreover, unless there is significant change quickly, the graph line will continue to go up as far as the eye can see, so that expenditure of a quarter of GNP on health care by the end of the century is a real -- and grim -- possibility. Such an eventuality would seriously impair the standard of living in the United States.

There are many proposals for reform. The best, in our view, is a Canada-style national health insurance. But because we spent ourselves into near-bankruptcy during the Reagan years, it would be all but impossible to achieve such a goal.

The very least we can do is adopt the proposals made last year by the bipartisan body known as the Pepper Commission and headed by Sen. John D. Rockefeller IV of West Virginia. That plan would cost around $24 billion a year, to be used largely as a carrot-and-stick incentive to assure that all employers offer some basic form of health care insurance.

That is about the most modest reform proposal that would have any hope of taming the monster of runaway health-care costs. Unfortunately, even that reform will not be possible unless President Bush weighs in quickly and seriously to address this moral imperative and national crisis.

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