With the upcoming presidential election, the media is filled with discussions of modeling the ailing American health care system after successful foreign models. Many consumes, reformers, and politicians are proposing drastic changes. A radical reorganization of the United States' health care system is irrational. Although the flaws of our government's delivery receive the most attention, the excellence of our system is largely taken for granted. The ideal solution is no to completely overhaul our current system by adopting a foreign or highly altered one. Instead, the greatest challenge is to maintain the American spirit and confidence while improving the delivery.

Aren't the American people in favor of a foreign model? True, Health Management Quarterly recently reported that 61 percent of Americans favor a system like Canada's. However, when asked in a survey, nationally, most people would respond negatively to the current system. Policies always look better on the other side of the boundary. What most Americans don't know is that in January 1990, the waiting list for heart bypass surgery in Toronto topped 1,000. If Americans had a delay of eight months for surgery, there would inevitably be a lawsuit. The threat of malpractice is so great that rationing would never work in the U.S. Yet, rationing delays are tolerated in foreign nations because the concept of malpractice doesn't even exist.

This sharp contrast is due to the fundamental differences in economic and political systems. The United States is a vast and disperse country. Our heterogenous culture of 240 million people does not lend itself to most foreign health care systems. The most appealing programs are essentially socialist, controlled and rationed by the government. Sweden is on such model that successfully uses rationing in its health care. In contrast to the United States, this social democracy generally has a homogenous culture concentrated in the warmer south. A socialist form of health care is ideal in Sweden, but obviously cannot work in the U.S. due to these topographical and political differences.

The United States is competitive. Most advances,technically and intellectually, have resulted from needs, expectations and demand. Consumer expectations force the development of new services and higher quality in medicine. These strengths of the American spirit should be applied to problems in the current health care system.

The high cost of adequate health care is one problem that is a major controversy to the American people. Medical expenses are twice that of defense and soon to exceed housing. Costs of necessary procedures are rising at unbelievable rates. Two major causes of this inflation are insurance and doctors' wages. The government loses $48 billion each year in lost revenue from tax exempted, employer-paid insurance. Yet the government does not give this advantage to individual health insurance holders. Instead, the roles of employer and private insurance should be reversed with one addition: the large employers should be offered a credit for health care costs to use towards their employees needs. Under this system, an individual would be able to afford better insurance, and the companies will still receive benefits. This "American style" solution offers insurance through the workplace, instead of through the government. Even though employers will remain to be in control of health care insurance, they cannot manipulate the cost control. Hospitals and health care professionals should refocus their efforts towards the patients. This change can only occur if the system becomes competitive. The consumer should have the right to seek out the best health care for the most affordable prices. By creating a competitive market, the American people would control the costs of health care, not just employers or insurers.

Doctors' fees are another highly expensive cost in medical bills. Physicians are in the top 3 percent of all wage-earners in the U.S. The cost of medical school is one cause of these high wages. However, other countries do not have this problem because the medical schools are state-funded. Another cause is the referring of patients for unnecessary tests. A model to consider as a solution is in Arizona. There, the AHCCCS program negotiates doctors' fees in advance. This is an incentive not to send patients for unneeded procedures to make more money.

All of these feasible solutions do not require major restorations, but build on the strengths already present in the United States. Severe compromises in our health care system should not be advocated not tolerated. Health care is a part of our culture. No country will every be completely satisfied with their health care systems. Changing the system will not prevent cancer, stop Americans from drinking, or prevent teenagers from smoking. Reaching a balance between government-subsidized health care, consumer based health care, and employer insurance will maintain American confidence, thus strengthening one of America's strongest advancing fields.

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