
              THE U.S. - DOES THE PRESCRIPTION NEED CHANGING?

                             By NORMA GREENAWAY
                                Southam News

     WASHINGTON - In a city where conferences and seminars are a dime a
     dozen, it's often tough to attract a crowd.

     Not so recently. Dozens of government, business, labor and health
     care representatives packed a small Capitol Hill townhouse for a
     policy forum titled, Canada's health care system: Hazardous to your
     health?

       See <03health> for a history of Canada's health care
         See also <28health>

     They heard about a shortage of organ transplant facilities north of
     the border, the long waiting lists for open-heart surgery, and
     about a two-year-old Windsor boy who died four hours before he was
     finally slated for cardiac surgery in Toronto.

     ``I don't know why the hell you'd want our health care system,''
     declared Michael Billet, head of Heartbeat Windsor, a private group
     that helps Canadians obtain needed surgery in the United States.

     In the next breath, however, he added: ``I wouldn't want your
     health care system, either.''

     Surveys indicate most Americans agree there is something wrong with
     their system. The upshot is a growing clamor for changes to their
     patchwork quilt of health-care programs, a mix of expensive private
     insurance and government plans for the poor, disabled and elderly
     known as Medicaid and Medicare.

     Two issues are driving the reform efforts. The first is
     skyrocketing costs which have pushed up premium payments for
     businesses and individuals by as much as 100 per cent in the past
     few years. The second is that 34 million Americans, almost 15 per
     cent of the population, have no health insurance, according to the
     latest federal statistics. Some 50 million are considered
     underinsured.

     Critics say it is unforgivable so many Americans lack basic
     coverage in a country that spent about $670 billion, or almost 12
     per cent of its Gross National Product, on health care last year.
     By contrast, health care spending in Canada accounted for about
     nine per cent of GNP last year.

     While there is broad agreement the U.S. health system is sick,
     there is no consensus on a cure. Indeed, one of the only subjects
     of agreement between opponents and proponents of major reform is
     that a government-run health care plan like Canada's probably won't
     fly in the United States.

     ``I personally like the Canadian model,'' said Ron Pollack of
     Families USA, a private lobby group for elderly Americans. ``But I
     have serious doubts as to whether we'd ever adopt it.''

     A Canadian-style national health care program is seen in many
     political, business and health circles as too expensive and too
     disruptive to implement here. Opponents, such as the American
     Medical Association, argue Americans have less faith in their
     government's ability to deliver services than Canadians do.

     They also say a national program would wind up reducing money
     available for specialists, thereby eroding the advances the United
     States has made in treatments and medical science.

     Analysts expect more modest reforms aimed at achieving universal
     coverage through a continued mix of private and public programs.
     The role of government would be bigger than it is now, but it
     wouldn't take over the system.

     A national bipartisan commission, popularly known as the Pepper
     Commission, recommended last year a $350-billion, five-year federal
     plan designed to guarantee universal access to health care for the
     working poor through either public or private insurance. The money
     would also be used to improve medical coverage for the elderly.

     For the most part, though, business would be required to either
     provide private health insurance or contribute to a new public
     plan.

     Several proposals are floating around in the U.S. Congress, and
     some 30 states are looking at plans for broadening health insurance
     coverage. Also, dozens of labor, business and citizens groups have
     formed lobbies to press elected state and federal politicians to
     get behind the reform efforts.

     Both the Republicans and Democrats have task forces on health care,
     and Senate Majority Leader George Mitchell has promised to
     introduce legislation soon that will provide universal coverage.
     Mitchell's legislation, still being written, would apparently be
     along the lines of what the Pepper Commission recommended.

     Optimism that all the talk might translate into action stems from
     growing evidence the issue has caught the attention of middle-class
     Americans.

     ``This issue is no longer an issue for the poor,'' said Pollack of
     Families USA. ``Now it's a big issue for business, a big issue for
     labor, a big issue for seniors who can't pay for long-term care and
     for families with children.''

     Steffie Woolhandler of the Physicians for a National Health Care
     Program said no legislative action is expected this year. She and
     others say their main goal now is to make health care reform a
     major issue in the 1992 presidential and congressional elections.

     ``The good news is that if there is enough public interest and
     pressure, the Congress is going to have to act,'' she said in an
     interview. ``The bad news is that they're going to have to be
     pushed.''

     The push is increasingly coming from constituents feeling real
     hardship, Woolhandler said. More and more elderly people are being
     wiped out financially with health bills, and increasing numbers of
     Americans suffering from such diseases as diabetes, cancer and AIDS
     either can't get anyone to insure them, or are being forced to pay
     exorbitant premiums, she said.

     A fresh Gallup poll of chief executives of the country's largest
     companies found that 91 per cent of those interviewed favored
     reform, although 66 per cent opposed a universal, government-run
     health care system. Most favored unspecified adjustments to the
     current employer-based insurance structure.

     Business complains it is being overwhelmed by rising health care
     costs that are forcing companies to stop providing coverage or to
     shift more of the costs to employees.

     The shifting of costs to workers has sped organized labor into the
     camp promoting national health insurance legislation. In February,
     the AFL-CIO's executive council effectively endorsed the idea of
     forcing employers to either provide medical coverage for their
     workers or pay a tax into a government insurance program.

     ``Everybody agrees the time is ripe for serious reform,'' Ray
     Abernathy, a spokesman for the Service Employees International
     Union, said in an interview. ``But it's all very mushy right now
     because there are 1,001 ideas out there but no consensus.''

     Bill Custer of the Employee Benefits Research Institute here
     agreed. ``There's a lot of smoke, but how much fire is there
     remains to be seen.''
