Troubled Health of the American Patient : An epidemic of medical problems, including insurance

For a majority of Americans, last week’s annual health report from Washington was encouraging. For millions of others, the diagnosis, delivered by Dr. Louis W. Sullivan, secretary of health and human services, was too gloomy to be cured by any prescription known to science. For all citizens, it is a call for action to reform the health system.

The most distressing report involved black Americans. Their life expectancy lags six years behind the national average. It is a reflection of the high rate of homicide and AIDS more than anything else. Murder takes black lives at seven or eight times the rate at which it claims white lives.

And the distressing news doesn’t stop there. For businessmen worried about health insurance costs that are nearly double those of five years ago, there was the reminder that the nation spends more for medical care than any other country--and yet still ranks 16th in life expectancy and 23rd in infant mortality. A recent poll conducted by the Gallup Organization for the Robert Wood Johnson Foundation found 91% of businessmen are persuaded that the health care system needs basic restructuring. As much as anything, the Sullivan report reinforces that impression and should encourage business to stay on top of the problem.

For most Americans, the report was positive. Heart disease and stroke continue a very gradual decline as major causes of death. Last year infant mortality took its sharpest drop since 1981. Average life expectancy is now slightly over 75 years.

But the murder rate rose from 8.8 deaths per 100,000 to 9.8 last year, and AIDS was close behind, causing 8.6 deaths per 100,000 in 1989.

THE UNINSURED: Among the more dismal aspects of the report was the increase in the number of Americans without health insurance of any kind, 16% of the population, or about 40 million. Add to that the 70 million Americans who are estimated to carry too little insurance to seek medical aid when they should and the number is perilously close to half of all Americans. Lack of insurance was more common in the southern and western regions: Nearly 35% of Mexican-Americans carry none.

The lack of access to health care was one of two central issues that surfaced in the business poll. The other was soaring cost. A majority felt that government intervention is needed to spark reform, but there were wide divisions on the details of just what form the intervention should take. Less than 10% thought that a federal health plan is the answer, although 24% said it may be an option some day.

THE OVERALL PROBLEM: Even the decline in infant mortality may have less to do with any basic improvement in prenatal or child care than with a new drug that helps prevent sudden respiratory failure in infants. Black infants continue to die in their first year at twice the rate of white infants. And the number of pregnant women who get prenatal care has dropped slightly in recent years. Even so, President Bush has proposed only a modest increase of $171 million for prenatal care in the 10 to 15 urban or rural areas with the highest infant mortality rates. Much of that money would be transferred from another program for women and children.

For big businesses, employee health costs have skyrocketed from single digits to 25% and even up to 50% of profits in recent years.

Responses have ranged from proposals for a national health care plan to a straightforward plan in Oregon for rationing health care. The Bush Administration has a number of task forces looking for the medical grail: better health care for more Americans at lower cost.

The search needs the most intense concentration by government, business, labor and the medical profession. The latest national health checkup tells why.