The United States is the chief victim of a worldwide epidemic of rising health care costs. Americans spent over $600 billion on health care in 1989, double the amount allocated for defense and 50 percent more than it devoted to education. Despite this embarrassment of riches, the citizens of the nation are not getting their money's worth. As much as $200 billion spent on health care last year was unnecessary, and 50 thousand Americans may have died from procedures they did not need. Constant criticism is being thrown at the government in opposition to these costs, but it is the public who can solve the problems of health care. By demanding low-cost, high-quality health care that is effective and humane, the problems of health care can begin to be solved.

There are two broad strategies for reform of health care. The first extends government regulation to medical prices. The new Medicare DRGs, or "Diagnostic- Related Groups," use this approach. The other strategy "the incentives approach," would shift medical choices and responsibilities to the consumer. More regulation may seem, at first glance, to be appropriate since it is the doctors and hospitals who have been raising prices.

However, it was in 1965, when medical costs began their upward flight, that Medicare and Medicaid began. Ten years after the enactment of these programs, hospital charges had risen 300 percent. In order for the costs of health care to be lowered, the problem must be attacked at its roots--in the marketplace. By lifting the price shield consumers must be exposed to actual health care costs. This can be don by taking the incentives approach, which has already reduced spending in some parts of the country. This approach offers consumers a chance to get low-cost, high quality care. Thus, it gives providers an incentive to supply the same. Rather than imposing complex and ultimately counterproductive schemes to regulate doctors and hospitals, now it is time to unshackle the consumer. The right of the consumer to exercise freedom of choice can attain what an army of bureaucrats can never hope to--cost-effective medical care for everyone.

What a generation ago was known as the "medical profession" is now referred to as "the medical-industrial complex." This huge industry has brought not only greater efficiency and productivity but also greater impersonalization on those who dispense medical service to the public. The air of the operating room, where once the doctor was sovereign, is now so dense with second guesses of insurers, regulators, lawyers, consultants and risk managers that the physician has little room to breathe, much less heal.

In part the problem lies with the failure of the profession and the government to police medicine adequately, since the stakes could not be higher. If a doctor is negligent, his patient may lose his vision, his memory, his mobility, or his life. The costs of malpractice insurance have driven hordes of doctors out of the profession. Those who manage to continue their practice may be forced to assume every patient as a prospective litigant. Such defensive tactics are anti-ethical to compassionate care: The doctor ends up being afraid of someone he/she wants to help, cautious about trying attractive new treatments, and aloof from someone in need of emotional support.In the end, the struggle between caring and curing is not likely to be resolved by government intervention or technological innovation. As a society we must reassure our health officials and reinstall confidence in the profession. The practice of medicine, though it may become ever-more precise, will never again be simple, never again cheap, and never again magic.

Although the problem of health care is of concern to everyone, it is especially so for the elderly. The increasing size of the aged population has resulted in an enormous burden on the health care system, resulting in a substantial share of its costs. For one thing, an increasingly large share of health care is going to the elderly rather than to the young. The federal government spends six times as much providing health benefits to those over 65 as it does to those under 18. A second concern is that the elderly, in dying, consume a disproportionate share of the health care costs. There is little incentive for politicians and government officials to think about, much less talk about, limits on health care for the aged. As a society we must make some choices. Is the future goal of medical science to improve the quality of old people's lives or to simply lengthen them? No matter how much we spend, the ultimate problem will still remain: people will grow old and die. We must devise a plan to limit the costs of health care for the aged under programs that are fair, humane, and sensitive to their special requirements and dignity. The government has a duty, based on our collective social obligations, to help people live out a natural lifespan, but not to extend life beyond that point. As a society, we must recognize the necessity of limits and accept decline and death. In the name of medical progress, we must reconsider the issue of health care toward the elderly and analyze a solution that will create a better society for all.

The American people must take the initiative and responsibility if we are to find a less costly, more effective, and more humane system of health care. We must stop spending all of our time talking about how much health care is costing us and trying to figure out how much of the cost should be shouldered by the government. Instead, we must rethink our values as a democratic society that are the basis for our government and its' programs. Only when we can focus on changes and reforms as opposed to point blame on the government, may the problems of health care be resolved.

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