America's medical bills are something else. They seem to come from a place where science has lost connection with reality, where bureaucracy and paperwork have no end, and a half-hour tonsillectomy costs what the average worker earns in three weeks. The prices are out of control. Examples: Annual dose of human growth hormone for a child with a severe deficiency, $20,000; coronary by-pass surgery for a 50-year old man, $40,000; cost of a bufferin tablet for a patient in a psychiatric hospital, $3.76; price of a modified radical mastectomy, $7,900; one day's intensive care for a crack baby, $2,000; a 50-minute session with an elite psychotherapist, $160; delivery of a baby boy by Caesarean section, $7,500.

Americans spend $23,000 a second on medical care, more than $2 billion a day, or $733 billion a year. That's nearly twice what they spent seven years' ago, including annual increases of 10 percent during the past two years. Unchecked, the U.S. medical bill will more than double in the next ten years to $6 trillion, crowding out spending for other important needs.

It's time for government to do something. Government's role should be to modify old programs and to create new ones to meet changing health care needs. Listed are some facts and possible solutions.

Medical, a $110 billion program, was started 26 years ago with a $5 billion budget and was designed to provide care for the elderly. But the program gives the same benefits to people who are well off as to the elderly. Although the elderly pay some of the costs, 90 percent of the Medicare costs come from payroll taxes on workers. The result of this is that the burden falls on workers who have no insurance of their own and may have trouble making ends meet.

As the U.S. population grows older, the burden of health care is falling more on younger Americans. There are about seven Americans under the age of 65 for every person over that age, compared with 11 to 1 in 1960. One of those younger Americans is unemployed and two are children. That leaves about four workers to support each elderly American, and one of those doesn't even have his own health insurance.

Government should slow Medicare growth and put it back to its original goal, which is taking care of people who need financial help. People who can afford to pay more for their own health care should do so.

Medicaid is the fastest growing spending program in the U.S. Medicaid will give out $58 billion in federal and state funds this year to give health care to 27.3 million Americans, which is an average annual cost of $34,000 a person. Medicaid looks after the 158,000 severely impaired crack babies born each year, which is $1.8 billion a year. It also looks after the 35,000 AIDS victims who have run out of money, the poor single mothers, and pregnant teens.

It doesn't do a very good job. Medicare is very wasteful, often requiring hospitalization where out-patient treatment would do. Some doctors refuse to treat Medicaid patients because of low reimbursement and the hassle of bureaucratic rules. The program is also target for thieves because of poor management. Medicaid pays billions in fradulent claims each year. Government should shut it down. Medicaid patients can receive better care and federal funds would be better spent under a more simple universal plan which would cover basic preventive treatment for Americans who cannot pay for their own insurance. Almost two-thirds of 500 senior executives surveyed last summer by the consulting firm, Noble Lowndes, said they support such a plan. To help pay for it, Congress should eliminate the $53,400 income cap on payroll taxes that funds Social Security. This would sharply increase payroll taxes for the wealthiest, but such a change would be a fairer way of dividing the burden which now falls more on lower income workers. Removing the cap would provide an estimated $25 billion in new funds for a universal plan. Congress should then move the entire Federal Medicaid budget to the universal health program which would give it $115 billion in its' first year.

Doctors seem to be disappearing. More than 570,000 practice medicine in the U.S. today, almost double the number 20 years ago. Yet, large areas (18 counties in Texas alone) have none. Rural America, as well as many inner cities, are facing a big problem in primary care. Communities need about 35,000 more general practitioners, according to most estimates. Doctors usually prefer more sophisticated practices, such as a specialist or a surgeon (who can make more than $300,000 a year, compared to an average family doctor's income of $96,000). The shortage of general practitioners leads to wasteful use of medical resources. Without a family doctor to keep track of their overall health, people must find their own way through a costly medical system, often getting high-priced help where the skills of a general doctor would do. Federal money pays for half of graduate medical education. Government could redirect as much as 50 percent of the 3.6 billion federal contribution to students who plan to practice general medicine.

Also, government should expand a three-year test project authorized by Congress lat year. The program gives up to $50,000 in matching funds to communities that finance medical education for physicians as well as other medical professionals.

Fear of malpractice lawsuits is a problem. These lawsuits drive doctors to perform many extra procedures to protect themselves from claims of malpractice. The American Medical Association estimates that defensive medicine adds $21 billion to the U.S. health care bill every year.

Unnecessary care also accounts for a large sum, up to $132 billion a year. Rand studies have found that in some regions of the country, as many as 44 percent of coronary by-pass surgeries and 64 percent of artery-cleaning carotid endarterectomies were unnecessary or highly questionable. Many doctors challenge such finding, arguing that it's better to make a mistake on the safe side.

Government should cap noneconomic awards for factors such as pain and suffering around $250,000. California placed a limit on such awards in 1975, and it now has some of the lowest malpractice premiums in the U.S.

Another wise investment for government would be to begin a program devoted to finding out which procedures and drugs are most effective. If doctors are supplied with guidelines about what works best in treating various ailments, they will feel less pressure to do things on a just-in-case basis.

BACK