In a small rural community in America today, an elderly couple huddle together in their unheated home--hungry, sick and without hope. They don't qualify for Medicaid in their state, though their total income is only a little more than $5,000 a year.

Meanwhile, in a doctor's waiting room across the country, a middle-aged woman studies a breathtaking bill for high-tech diagnostic tests and puzzles over a complicated health insurance form.

At a private hospital in another community, a frightened young mother is referred by an impatient clerk to a distant public facility where she can get free care for her sick child. This hospital does not accept patients without insurance or cash. She has neither.

Health authorities say tragic incidents like these occur thousands of times each and every day all across the United States. Although America is endowed with some of the most advanced technology and best-trained doctors in the world, many Americans find themselves cut off from access to the health care system. "In America, health care is a privilege, not a right," sums up United States Representative, James Scheuer (D New York).

Expenses of health care have been running at way more than $400 billion dollars, currently 12.3 percent of the gross national product. If the Department of Health and Human Services were a country, its budget would rank fourth behind those of the United States, Japan and the Soviet Union. "Unless changes are forthcoming, health care costs will reach $1.5 trillion by the year 2000."

Despite our tremendous outlays of money, the statistics surrounding the problem are staggering. Thirty-one million Americans now have no health insurance; 70 million more are underinsured, and 3 million are denied coverage because of existing medical conditions. The American College of Physicians reveals more than a million patients are turned away from hospitals each year because they have neither insurance nor cash to cover the bills.

Inaccessibility to health care is often most pronounced in the groups that need it most. Many of our elderly citizens fall through the gaping cracks in Medicare; numerous services, most notably long-term care, are not covered at all.

Similar problems exist with the Medicaid program, which was established as a joint federal-state health care safety net for the poor. Today, the 23 million people covered are, in fact, the poorest of the poor. Medicaid supposedly insures those unable to pay for coverage. But as hard-pressed states have found it increasingly difficult to pay for the program (they put up 68 percent of the total money), they have tightened eligibility standards.

Resulting from this , fewer Americans qualify. They earn too much money to be covered but too little to afford care.

The concept from which today's health care system evolved got off on the wrong foot more than 60 years ago and has been out of step ever since. Doctors were--and still are--reimbursed according to a set schedule of fees, or on what insurers consider 'reasonable and customary' charges.

This concept, which encourages health care providers to offer ever-increasing numbers of services at ever-increasing prices, is the heart of this country's health care financing system--and the core of its problems today.

Some authorities insist that overuse of medical procedures has reached epidemic proportions. Dr. Robert Brook, director of health sciences for the Rand Corporation, says that as much as 20 percent of all medical procedures and treatments are completely unnecessary. This includes as many as 44 percent of the coronary bypass surgeries, 64 percent of arterectomies, and 25 percent of heart-pacemaker implants. There is more to the problem than providers' greed or patients' insistence that something be done to relieve their discomfort, other health experts point out. There is very real concern over the possibility of malpractice liability that could lead to astronomical court awards against health care providers. In one recent poll conducted by the American Medical Association, 70 percent of doctors admitted practicing defensive medicine--ordering numerous diagnostic tests, referring patients for consultations with specialists, regardless of cost--simply so they can demonstrate in court that they did everything any doctor could do. The majority of doctors jump to their own defense basically saying, "It is better to be safe than sorry.". . . even if it costs the government and taxpayers billions of dollars every year.

The diagnosis has been made: America's health care system is critically ill, and the cure is elusive. "Our system has a lot of strengths, and we don't want to lose them by tossing it out," says Dr. Louis Sullivan, head of Health and Human Services. According to a recent Washington Post article, he is reportedly looking at the following: * Private health insurance rate reform * Tax credits targeted to modest-income people * Malpractice reform to discourage so-called "defensive" medicine * Taxing as employee income the health insurance premium employers pay. Authorities agree there is no easy solution to the problem. Each proposal has its drawbacks and costs. Those who have taken on the cause continue to search for ways to ensure universal access to health care without emptying the national pocketbook.

In the meantime, what can we as individuals do to protect our own access to quality medical care while helping reduce the skyrocketing costs of the health care system? The first step, experts say, is to concentrate on our own health and quality of life.

The focus of the nation's health care system must be changed from sickness care to wellness promotion. Simply implementing what we already know--changing behavior and providing preventive primary care to all--would go a long way toward reducing our health care costs.

Where does American health care go from here? It is a question the nation must address effectively--and soon.

"Our fate is in our hands. We must discipline ourselves and our individual and collective wills to act with courage and compassion."

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