Health care cost in America is at a crisis-level. Because it is one of our number one concerns today and for the coming years, I would like to analyze just how deep this problem goes.

Millions of Americans have no health insurance, no health care programs, and avoid health care altogether because they are afraid to incur the liability of expenses. Millions more obtain health care, but lose all of their possessions, all their wealth, all their savings and retirement in paying off simple care. Still others have what they think is adequate coverage, but the deductibles are too high, there is no catastrophic loss, and when they do finally need the help they think they had, it wipes everything out.

Here are some more examples:

Annual dose of human growth hormone: $20,000 Coronary bypass surgery: $49,000 Cost of a Bufferin tablet: $3.75 Modified radical mastectomy: $7,900 One day's stay for a crack baby in intensive care: $2,000 50 minute session with a psychotherapist: $160 Caesarean section: $7,500

Not only are the above singular, high-cost example of certain procedures, but the basic cost of an office visit, a wart removal, an ingrown toenail, or your $500/day average hospital rate are out of control and getting worse. Well above the annual rate of inflation, certainly well above the annual increase in wages, who pays these huge bills?

Paying more than 40 percent are federal, state and local governments who presently pay a majority of all health care costs and care for some 33 million elderly and 22 million poor Americans.

Paying 30 percent of the costs of health care are private insurance companies, which offer policies to those individuals who choose to buy their own health insurance. Most health insurance policies, however, are purchased as a benefit for their employes by employers.

That makes the remaining 30 percent of the health care bill the responsibility of the 37 million Americans who either do not have any health insurance at all, or are forced to pay out of their own pockets because they are self-employed, unemployed, or because their employers just do not offer them health insurance. Having confirmed the existence of a problem, this paper will continue to analyze, to some degree, the nature of the health care problem. Followed by some of the pros and cons of each and what I believe is the near-term solution to the crisis and why it should work, I will not address three proposed solutions: (1) developing a national health insurance program, (2) requiring employers to insure all workers, or (3) requiring individuals to buy health insurance of their choosing.

Let's look at the first option. It would follow the lead that Canada has taken in this area. In that country, where a national health insurance was adopted some 20 years ago, provincial governments pay the bills, set the doctor and the hospital fees, decide what new equipment can be purchased, and finance insurance by a combination of employer and employe contributions. I believe that it is more equitable and cost efficient than our current system because all Americans would be treated equally, regardless of income, and there would be no deductibles or copayments involved.

On the other hand, national health insurance may not be the answer because it essentially involves very tight regulation of a presently private system, and our country has, in general, been moving away from and not toward it. In other words, it is a socialized medicine where, foreign to American temperament, everyone gets the same piece of the pie.

As to the funding of national health care, would it come from an income tax, a sale tax, the national debt, or where? It would be a huge program that would have to be paid for somehow, and perhaps this is the biggest determinant to this option.

The second option to examine is that which would require all employers to insure all workers. Under this proposal, businesses would be required to provide health insurance to all of their employes. Self-employed individuals would have a choice of either providing insurance or paying into a federal fund that does the same thing. To control costs, a national board could be appointed to oversee the matter, and it would set spending limits, administrative procedures, and so forth.

The positive aspect of this is that it is not foreign to the American way of thinking. It is basically what we do now, but we are doing just too little of it. That is, employers provide insurance, but not total insurance. Not a radical concept, it is just expanding on what we have got. Perhaps this is the only advantage.

Negatively, it will drive millions of small businesses to bankruptcy, and it will make less profitable virtually all of big business. All of the cost will be returned to the purchaser in the form of higher prices for goods, and this will surely lead to an economic recession.

Furthermore, with the latest emphasis on foreign trade and American competitiveness overseas, this will make American firms much less proficient because the cost of their goods, whether it be an automobile, a food product, or whatever, will just have to be sold for a much higher price because of the cost that has gone into it.

Finally, a third approach to health care would be to require individuals to buy insurance from whatever means they choose, and providing them several options to do this. It would place the burden of the responsibility into the hands of the ultimate user and not into the hands of the employers or the government. The people themselves, those who are to benefit from the insurance under this proposal, would be required to make the choice of how they are going to cover it. Specifically, they would have to buy their own insurance from private companies. And, once again, funding becomes a question. An answer is, of course, that the employers who presently withhold pay and require employes to pay into insurance funds would forfeit these funds to the individuals in the form of higher wages, giving them more means to buy these policies so there is some cash flow compensation by that definition.

But what of the people who will be trying to buy cheaper insurance by purchasing those policies with high deductibles, and as a result, because the deductibles would be at their own cost, will not seek the routine, preventive care that they need?

All of the above options highlight one singular problem:the cost. Who is going to pay?

The answer is very simple. The user, one way or another, because whether the federal government funds it or the individuals buy the programs, it all comes back to the individual user.

So the question becomes just how much will individuals be willing to pay for this privilege, and how much are they willing to safely take on as a risk in reallocating their limited budget? It is simply not possible to offer unlimited health care to everyone and expect no one to pay for it. Nor would it be fair for certain classes or Americans, the well-to-do and so forth, to receive care while the have-nots do not.

It is my opinion that the first action by the government must be, and it happens to be the simplest, to mandate a limit on some of the costs that are spiraling out-of-control. And this would be easy to do. Limited malpractice insurance, establishing a going-rate for common procedures and routine office visits, and penalizing those caregivers who charge above that, putting a cap on all medically-related costs to be no more than the annual consumer price index are all actions that can be done with the stroke of a pencil in 30-days'-time-or-less through a federal bill.

The next thing to do is to settle on one of the above three health care options, or propose something different.

It is my belief that the third option, one that forces Americans to buy their own insurance, is probably the least viable. Talk about being un-American, forcing people to cover themselves is not the way that we do business. So we will rule that one out.

The second, which requires businesses, or employers, to provide insurance for everyone, runs great risk with the economy in general and with the welfare of all Americans and their competitiveness overseas. For reasons I suggested earlier, it would wipe out thousands of businesses because of their increasing costs, drive us deep into recession, and in turn would generate less money for the programs that we are trying to develop in the first place.

That leaves us with the national health insurance system.It has a lot of short- falls,it has some obvious advantages. But I think that the first step is to decide that we are going to make it work, and then draft the details, present, refine, and implement them to the public under a "trial" basis for a year, to be redone after that.This national health care system would probably become more and more viable over the years as people's income catches up with these costs.

In summary, the biggest problem in health care is the cost, and the United States can do a much better job. American people are passing on to their following generations a problem bigger than the S&L debacle, and even bigger than the national debt that we will be saddled with for years. But this is one we can do something about, and the time to do it is now.

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