Dr. Charles Everett Koop, surgeon general of the United States during most of the 1980s, was perhaps the most influential person ever to hold that office. Now 79, he remains an important voice in the national health care debate.
While in office, he criticized the tobacco industry and he endorsed sex education in schools as a way to prevent the spread of AIDS -- thus becoming one of the few surgeons general sufficiently outspoken to attract both enemies and supporters.
Dr. Koop now is head of the C. Everett Koop Foundation, a medical think tank at Dartmouth College; yesterday he was given a $250,000 Heinz award for professional excellence. He spoke about the virtues and problems of the U.S. health care system with Sun staff writer Richard O'Mara.
Dr. Koop, you have recently said that the climate in Washington is "downright hostile to health." What did you mean?
I was referring to the fact that the health of the nation is caught in a pincers movement between the administration and Congress. They are both eliminating [and] downsizing offices and programs that are critical to the health of the people.
No matter how you slice it, the various agencies that have been in existence for many years to run the public health of this nation are either gone or so weakened they can't do it. I don't think that is good for the health of the nation.
For example, a stellar program for this country was the Office of Disease Prevention and Health Promotion. It's been eliminated. It's gone. When you eliminate something as important as prevention of disease and promotion of health from the government, I think you undercut the health of the American people.
President Clinton's health care plan was doomed, some believe, by opponents in effect saying, "What health care crisis?" Does a crisis truly exist?
I cannot believe it is not a crisis when every month an additional 100,000 people lose their health insurance. When every year 250,000 people declare bankruptcy because they were trying to pay their health bills but couldn't. When we have 40 million people who are uninsured for some part of the year.
Where people cannot carry their health insurance from one job to another and are held hostage to it, in order to keep insurance, let's say, for a child who has a chronic disease problem. And where the existence of a pre-existing condition or injury can keep you from being insured because you are blacklisted by all insurance companies in the land.
I think that's a crisis.
Do you have any specific remedies other than those being
I think there's no doubt that Medicare is out of hand and has to be altered. What I think should have been done was to start with a fact-finding commission. Postpone the decision to cut it for a year, because one of the things we've never decided in this country is, what is basic health care? What does that constitute?
There has to be a realistic expectation of people over the age of 65 to what they are entitled to.
I think the thing what's wrong with government programs is their lack of flexibility. For example, suppose that you and I were both of the same age and we both needed a knee replacement. And one of us had neither the will nor the muscles to use the new knee, and the other one had both the will and the muscles. We would both be treated the same way. And I think one of us should be turned down and the other get it.
So is there an ethical dimension that's being neglected?
Let's take some of the most expensive things we do, such as liver transplantation.
Is anybody entitled to two liver transplantations before everybody who needs one gets the first? Should somebody who had demonstrated his inability to take charge of his own health by becoming an alcoholic, should that person, at the expense of the public, get a new liver?
We've not heard of a health care crisis in Canada, or in Germany or England. What do they do that we don't?
If you go back to the three points that I mentioned that I think make up our crisis -- that is, the tremendous number who are not insured, the lack of portability of health insurance, and the pre-existing condition [that prevents someone from buying insurance] -- all of those are eliminated in the countries you just mentioned. I think the health care available in this country exceeds the health care in those countries, but so many people cannot access it.
You've said that one of the problems driving the present crisis is that U.S companies can't compete with foreign companies because of excessive health care costs. Can you explain?
The whole economic problem of health care started during World War II. There was a freeze on wages, and yet there was tremendous competition for company A and company B to get workers. To entice people to leave one job and take another they couldn't raise the salary. They began to offer health care.