WASHINGTON. — In a recent column I documented the woes of a U.S. health care system that is the shame of the industrialized world. I continue to question how we can spend $2 billion a day, more per capita than any other society, and still wind up with 60 million Americans getting little or no meaningful health care and with 60 million more with insurance that won't meet the test of serious illness.
Now I'm going to explain why we're in such a health-care mess:
* Government intervention over the last 30 years has been half-hearted and ill-conceived. Efforts have been made to ''sneak up'' on a system of universal health care because politicians were afraid to challenge head-on a capitalistic, ''laissez faire'' medical-care system that is both outmoded and in many respects uncaring.
* We have had a decade of White House leaders who have had contempt for the poor, so Medicaid, designed 25 years ago to be the health savior of poor women and their children, has been ripped off and ill-funded to the point that the entire program is at death's door. Congressional Quarterly recently reported that ''an increasing share of Medicaid is going to nursing home care for the elderly (34.1 percent of spending) and to services for the blind and disabled, especially the mentally retarded (38.3 per cent) . . . Medicaid still reaches only half of those officially classified as poor.''
* Old-fashioned American greed corrupts the entire health-care system. The availability of good medical care for a poor child using Medicaid is declining every year because Medicaid fees fall well short of what a doctor can get from a patient with private insurance. A recent survey found that 23 percent of pediatricians won't accept Medicaid cases at all and that 39 percent limit the number of Medicaid cases they will take. A congressional panel was told that in New York City many of the doctors who treat Medicaid cases are poorly trained, incompetent, dishonest and sometimes do more harm than good.
Medicare, which pays for health care for 34 million elderly and disabled people, saw costs rise phenomenally for hospital X-rays, CATscans, lab tests and other procedures. So in 1983 Uncle Sam put a cap on payments for in-hospital care. What happened? Hospitals and doctors began providing these services in outpatient clinics so they could charge fees well beyond the caps. These outpatient charges rose three times as fast as those for patients in hospitals.
* ''New medical technology'' has become the umbrella under which anyone sick in the United States gets soaked in a storm of greed that leads to our paying fortunes for diagnoses and treatments without gaining anything in life expectancy, infant mortality or other indicators of good health.
We are victims of a war in which, for example, every hospital in this town wants to claim that it is the medical technology leader. One boasts it has a simple CATscan, another advertises ''computerized axial tomography,'' only to be upstaged by one offering ''magnetic resonance imaging.'' Every hospital has to have the latest, and once it gets it, has to pay for it by telling patient after patient that he or she must spend up to $2,000 for a whirl on the new machine, even if they don't need the new machine.
In some towns, doctors form joint ventures to buy a super-costly bit of technology, and each doctor-investor is tempted if not obligated to get as many patients as possible to contribute to the amortization of his or her investment.
Efforts are under way in Congress to put an end to all these screw-the-poor, rook-the-middle-class and soak-the-rich health-care practices. Sens. George Mitchell, Edward Kennedy, Don Riegle and Jay Rockefeller have taken a powerful initiative toward a long-overdue overhaul of our health-care system.
They just might provoke the Bush administration to come out of hiding.
Carl T. Rowan is a syndicated columnist.