Even Rich Kuwait Hit by Huge Medical Costs : Mideast: Government no longer believes it can pick up the tab for everyone. Health insurance tax weighed.

In this ultramodern, oil-rich emirate, Wali Thaab was recently zipping along the Al Safar Expressway toward the capital at sunset when a herd of renegade camels suddenly wandered into the fast lane.

Thaab swerved, crashed through the livestock and slammed into the guardrail. The windshield shattered. It shredded his face. His pregnant wife lay comatose beside him, victim of a concussion.

The mishap was not unusual in Kuwait, where, as in many developed nations, traffic accidents kill or injure many; car crashes claim at least six lives daily here, ranking as this nation’s leading cause of death.

But what happened next to Thaab and his wife in this, the world’s ultimate welfare state, would--at first glance--make Hillary Rodham Clinton and advocates of the Clinton Administration’s health care reform package heave a sigh of envy.

Ambulances rushed to the scene, pulled Thaab and his wife from the wreckage and sped off to two nearby hospitals. Both crash victims were wheeled into state-of-the-art intensive-care units, where they were X-rayed, received intravenous antibiotics and even were tested with costly brain scans.

A plastic surgeon meticulously sewed up Thaab’s face; his wife, her injuries deemed too serious for Kuwaiti medical expertise, was flown--first class--to London for treatment.

Every bit of the care was delivered free.

Never mind that the Thaabs, like all 1.43 million residents of this wealthy emirate, never paid a penny in taxes, as Kuwait has no taxes. Never mind that there also is still no health insurance of any sort here. The government picked up the tab, just as it has for hundreds of thousands of Kuwaitis cared for each year in government hospitals for everything from common colds to heart triple-bypasses.

But even in Kuwait--where it would seem that a wealthy government offers ideal, affordable medical treatment for all--there is a deeper reality that illustrates just how universal is the health care crisis now facing America: Even here, health care is proving to be a severe drain for this nation, whose residents have enjoyed the shared benefits of oil wealth.

But at a time when oil prices are at a record low for recent decades, Kuwait has also been forced to spend tens of billions of dollars rebuilding after Iraq’s invasion and seven-month occupation.

Kuwait suddenly is facing budget deficits. Its officials are confronting ballooning expenditures, such as Thaab’s wife’s medical flight to London, and defense spending so lavish it averages $400,000 per Kuwaiti soldier. And officials are fast realizing that the government can no longer pay the emirate’s medical bills alone.

So, for the first time ever, the government is considering an income tax to help underwrite a national health insurance fund, spawning a debate that hits so close to home among Kuwaitis that many diplomats here fear that it could lead to wide unrest and, ultimately, political instability.

“The money is the core of it. People see the social welfare system fraying at the edges in all areas--health, education, government salaries--bread-and-butter issues for all Kuwaitis,” one Western diplomat said. “The question is: How will the people react when the government asks them to start paying for things they took for granted would be free for generations?”

For Kuwaiti doctors, fundamental changes are not only inevitable but essential if the emirate is to continue providing basic health care for all and to improve its advanced medical capabilities for many.

“The system will collapse if you take too much money from the people, but also the system will collapse if it remains free,” said Dr. Khalid Sahalawi, one of Kuwait’s most prominent physicians.

Sahalawi, director of the state’s Mubarak Hospital emergency department, has seen firsthand the critical holes that have opened in the emirate’s care system, particularly in the 2 1/2 years that Kuwait has sought to repair the damage that the Iraqis wrought, leaving the emirate a wasteland of burning oil wells and gutted neighborhoods.

The government has rebuilt its 17 hospitals and reopened 54 regional primary health care centers. It has re-created its prewar staff of 2,500 doctors, 8,000 nurses, 4,200 medical technicians and 5,200 administrators.

But it is not just the buildings, it is what’s inside that counts, experts such as Sahalawi said.

“If you look closely at Kuwaiti health care, it’s a disaster,” he said. “OK, you treat them. But they don’t receive optimum care and investigation. We need to improve the quality of our general physicians. The quality of care in Kuwait also is going down because we can’t afford to hire top specialists; 20% of all trauma cases die before they reach the hospital because we don’t have enough paramedics. And all of this is because everything is free, and the government is short of money.”

Underscoring the cost of Kuwait’s system is the emirate’s program for treating cases that require more expertise than is available here.

The government spends tens of millions of dollars each year sending critical cases to Britain, where at least one companion for each Kuwaiti patient also receives a $100-a-day allowance.

The essentially free system has created its own problems in Kuwait: Because there are no charges for any service, injection or pill, and because care at the primary clinics is considered inadequate, Kuwaitis flood hospital emergency rooms, some for matters as simple as a cold.

“At least 80% of the patients we see today in this emergency room shouldn’t come to the hospital. They should go to the primary care clinics,” Sahalawi said.

Those long waits, combined with the popular perception that government health care is eroding, have helped to feed a burgeoning private sector of clinics, hospitals and moonlighting government physicians.

Occupancy of the government’s 4,000 hospital beds is decreasing, as the number of private clinics has grown this year to almost 400; the flourishing private health care here is all the more astonishing, considering that the government charges just $3.33 for a private room with television and bathroom, as compared to the private sector’s $150 nightly charge.

Part of the reason for the private sector growth is psychological, said Dr. Khalifa Sakabi, planning director of Kuwait’s Public Health Ministry, adding: “Our people have money of their own, and they have it in their heads that the care in the private clinics is better. But they are the same doctors, so really, it’s the same.”

But he added that another reason for the private sector growth is a new set of financial realities for doctors themselves.

With top government salaries of $80,000, Kuwaiti doctors are opening clinics to augment their incomes; the government permits this largely to prevent the brain drain that has plagued the medical sectors in other developing countries.

With so much money now pouring into the private sector and the government running short on its massive medical subsidies--a system so generous its annual budget averages $533 for each man, woman and child in Kuwait--even government health planners said a change is needed.

Already, the government has taken a first step. Earlier this year, it started charging nominal fees for the most advanced diagnostics--CAT scans, ultrasound and non-emergency X-rays--but only for non-Kuwaitis, who make up about half the emirate’s population. The next step, said physicians such as Sahalawi, should be national health insurance, financed from a relatively small 2% tax on all Kuwaiti incomes.

Government health planners disagree.

“In my opinion, the solution should not be health insurance,” said Dr. Medhat Abdel Aziz, an Egyptian medical expert who has worked for seven years as chief planning physician for the emirate’s Health Ministry. “All the experts who have visited here have said that as long as we have this system, we should stay with it. If you have one sole, all-powerful source of finance for health care, why change it?

“Of course there are a lot of lessons you can get from the mistakes made in the United States, and this may well be among them,” he added. “It’s not an easy matter to change the system.”