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I ymmigw I A BIOO&X CT~ Health care s This is the first in a three-part series on health care refonn by Dr. David Adcock, chairman of the radiology department in USC's School of Medicine. T u^nnu is auyuuuy icauy scuuus auuui ncdun edie policy reform? Every major magazine seems to have an obligatory health care policy article. Newspapers run multi-column articles at least weekly and television does its share to keep the ( topic before the public. Most of the "health care" discussion seems to really be about medical care specifically, addressing issues of access to the traditional, allopathic medical practice system. Providing universal access to good, quality medical care at affordable prices does seem to be the central problem requiring a major change in public policy. There are many aspects of daily life which may have greater effect on health than does the * availability of medical care. But at the moment, the attention of the public and the politicians seems to be focused on developing a satisfactory arrangement for assuring access to the services of physicians and hospitals. It is possible that all of these activities are really off-the-track. The real problems of the medical care system could be resolved outside of the political arena simply by more informed and thoughtful behavior of the consumers, combined ( with more socially concerned behavior from providers. Most people only want to be able to consult a competent physician, when needed, at an affordoK1i3 nriop Thou o 1 er\ hiiro thn nVrvaototirvn thot auiv puvv. i nvjr aiau uavv uit tApvtiauuu uiai, when hospitalization is required, it will be possible to pay for that hospital care without being driven into bankruptcy. In a society with these reasonable expectations for availability, it should be a relatively simple matter to provide medical care for the truly indigent population through publicly funded programs. So why is medical care so expensive that people with average incomes are worried about being able to afford it when needed? The first, and most commonly acknowledged 1 problem, is that the system which has evolved in the United States is extremely complex, with the payment for medical services usually made by a third party, like an employer or health insurance provider. This system of third party payment has resulted in complicated billing and payment methods using a variety of nonstandard forms for managing the claims. The many procedural incompatibilities result in a very expensive payment system for medical services. Although this may be the most frustrating aspect of the existing system and the absolute cost is large, this is not where the major cost problem lies. I tJE Jack Dunn Editor in Chief C.E. Holman Managing/Viewpoints Editor Carson Henderson Copy Desk Chief Radhika Talwani Carolina! Editor Andrew Borgert Sports Editor Eric Glenn Photo Editor Brooke Pippen Staff Photographer Keith Jones Darkroom Technician The Gamecock is the student newspaper of the Universil South Carolina and is published four times a week on Moi Wednesdays, Thursdays and Fridays during the fall and sp semesters and weekly during both summer sessions, with I exception of university holidays and examination periods. Opinions expressed in The Gamecock are those of the e< or author and not those of the University of South Carolin; The Board of Student Publications and and Communical the publisher of The Gamecock. The Student Media Depai is the parent organization of The Gamecock. IG J f \ F ystem requires j mm David "jf A d c o c k Columnist i If there were sufficient consumer demand for a < simplified system or, better yet, if there were a ' willingness for the primary users of the system to i become more directly responsible for their own : medical care costs, the complexities of the current system could easily be corrected. A second and larger problem is the way medical services are priced. Over the past several decades, the pricing of medical services has, to a large extent, become disconnected from the actual cost of providing those services. This-has occurred for many apparently good 1 reasons in a complex system in which certain services could not be billed in a way which would recover the total cost while others, reimbursed through insurance programs, could be ] priced well above the actual cost. Particularly in the hospital setting, this has led to the shifting of costs from undercompensated services to proce- 1 dures for which the payment is easily obtained. i Although this seems like a reasonable approach to solving the immediate funding prob- < lems, it leads to distortions in the pricing system < which ultimately make it impossible for even a well-informed consumer to understand what the price is an individual service and whether or not . it is reasonable. By any of the usual standards of commercial profitability, the current pricing of : many medical services is excessive. : This society has not yet had a serious debate i about what is a reasonable level of compensation < for the providers of health care, but when ] provider incomes are compared to other stan- i dards of compensation such as the average indus- ] trial wage, the incomes in the United States I appear to be large relative to those in the rest of the world. This trend toward overpricing medical services can be successfully resisted by consumers even in the health care market. Frequently, people express the belief that they cannot refuse to purchase medical care services when they are needed, but that situation is only true for a minority of medical care situations. For many routine or elective services, it is possible to negotiate on the basis of price and even refuse to purchase the service if the price is considered to be excessive. A small amount of this wellinformed and assertive consumer behavior is likely to be more effective in controlling unreasonable price increases than many of the proSean McGuinness Graphics Editor Paul Jon Staff Cartoonist Patti Tomanio Acting Coordinator Laura Day Production Manager Jim Green Assistant Production Manager Shannon Wadford Production Assistant Renee Gibson Advertising Manager Eric Collins Faculty Advisor ty of Change of address forms, subscriptions, requests and idays, other correspondence should be sent to the address bel 'ring the The Gamecock Student Media litors University of South Carolina a. Columbia, S.C. 29208 Jons is rtment NEWSROOM 777-7726 ADVERTISING 777-4249 i j I i > revamping posed health care policy manipulations. The third and most costly aspect of the medical care cost dilemma is the inappropriate use of medical procedures. Although many people would view this as a simple problem, such as using the hospital emergency room for minor illness when that consultation could be done at much lower cost in a private physician's office, the problem is actually more complicated. Because many of the inappropriately utilized procedures are recommended by the medical :are providers, it is difficult for the consumer to understand what is actually necessary. There are many technological advances in medicine which seem to have great potential to improve health when evaluated by a well designed scientific study. Because there is great public interest in medical advances, favorable findings from these studies are rapidly publicized and have become "must-have" items for individuals who believe they are afflicted with medical problems which can be relieved or cured. Unfortunately, many of these advances are not so efficacious when applied in the real world of multiple providers with variable quality inconsistent follow-up and predatory pricing in our system. Some medical procedures are used which, when carefully studied, appear to have no positive impact on the health status of the population receiving the procedure even though some individuals may benefit. This kind of provider and consumer behavior results in increased medical care costs for the society with only marginal, if any, benefit in health status. It is probable that great cost savings could be achieved if there were public consensus on the appropriate use of these relatively high-cost medical care activities. Unfortunately, in this society, relatively little is being done to determine what is the predominant position on these questions which involve complex ethical principles and incite deep emotional feelings. As a nation, we should be developing the appropriate process for discussing and resolving these questions. Until our population, the consumers who create the need for the medical care expenditures, develop more informed and assertive consumer behavior and the providers of medical care become more interested in the public health than their own gain, it is unlikely that any political process will be able to create a medical care system which will satisfv the maioritv of the neonle of this country. Dr. Adcock teaches and practices nuclear medi' cine, is board certified in the specialty of pre' ventive medicine and public health, and has worked in the U.S. Department of Health and Human Services. |m The Gamecock is interested in the input of students, faculty and staff on the issue of health care reform. In the space provided below please answer the questions listed below. Then, clip out this coupon and return to Room 321, Russell House or mail to: The Gamecock, 1400 Greene St., Columbia, S.C. 29208. 1. To me, the most pressing health care issue is: 2. I would like to see health care reform in the following area, and I think that (your idea) has the ow. responsibility to reform it: * Crime bill? Clinton plan offers no preventive measures With the unveiling of President Clinton's crime bill twelve days ago, a new era in combatting crime has begun. Or so the Democrats would like Americans to believe. One Clinton executive order calls for $3.4 billion to be spent over 5 years to hire an additional 50,000 police officers, only half of what he promised Ln the campaign. This money only covers one-fourth the amount needed to train, equip, and pay the officers for five years. Additional funding will have to be raised at the local level to make up for the lack of federal funding, translating into higher property and sales taxes and increased fees. Crime has been a major problem throughout this nation's history. For the past decades, however, crime has turned both the inner cities and outlying communities into seething cauldrons of poverty and corruption. Events over this violent summer have formed the backdrop for the Clinton crime bill. In addition to the attack on children in a swimming pool in Washington and on a law firm in San Francisco, Columbia has seen its own share of violence. A bloody shoot-out over drugs at a Waverly Street apartment complex in June left two people dead. Also, in July, a sheriff's deputy was found dead in a burnt car on Two Notch Road. There is a desperate need for more police officers on the streets, however the officers the plan calls for will mast likely be distributed into larger crime-ridden cities, like Detroit and New York, leaving smaller cities, like Columbia, in the lurch. What is likely to happen in the ping-pong political funding process is that Congress will appropriate a much smaller amount and call for, at the most, 25,000 new officers. Fifty-thousand new officers is hardly enough to combat the gangs, pimps, drug dealers, or even the white-collar criminals. Like almost every previous crime bill, they focus on reactive measures rather than proactive measures. The cheapest, most effective ways of preventing crime are through education, economic development and community policing. Further education allows people to become more enlightened and more capable to discern good from evil, right from wrong. Clinton's crime plan also calls for $100 million in college scholarships, if students would be willing to serve four-years in a "police corps," a government sanctioned form of community policing. Community policing, like neighborhood watches, has proven consistently to be an effective way of preventing crime. What Washington needs to do is put more funding into preventive measures, that way they can spend less on reactive solutions. Bosnian conflict? Military intervention only way to end war For more than one year now, Americans have watched the brutal images of the Bosnian civil war. With the noose slowly tightening on Sarajevo, it appears that the war may end soon. All of the involved parties have committed atrocities, and if they were to be brought before a war crimes tribunal, they would most likely be found guilty. Despite all the murky reports about the war, one thing is absolutely clear: the United States has sat back and done nothino Hpftsivf* ctnri if '"O ? The Bush and Clinton administrations have done nothing as both sides continued to butcher each other. When reports of the death camps first became known, then President Bush did nothing to stop the inhumanity. Instead, he sent troops to Somalia on a relatively easy public relations mission. President Clinton campaigned on a platform of military intervention in the war, instilling hope into the Bosnian people. Once he realized the magnitude of the war, he quickly backed out. Earlier airdrops of humanitarian aid proved to be a dismal failure, and now the heated rhetoric by Secretary of State Warren Christopher hinting of possible U.N. or NATO intervention seems like more empty promises. Europe is equally guilty for sitting on their laurels. Talk of possible land concessions echo the talks between British Prime Minister Chamberlain and Adolf Hitler. When it comes to military intervention, Clinton and Bush have been pathetic Hamlet-figures, cowardly debating whether to fight or not to fight. However, to fight or not to fight is no longer the question. The time has come for America to lead definitive action against the Serbs. As the only superpower left, it is our duty to spearhead any form of military intervention. Military experts feel that strategic bombing of the mortar sites will be enough to scare the Serbs into withdrawing. Many of these men were the same "experts" who thought that strategic bombing would make the North Vietnamese withdraw. If the United States is going to become involved in military actions, then there is only one course that can be followed: Full-scale intervention involving air power and ground troops. Thp snfptv nf thp trrvnnc ^innnt ho mmrantuort mhifh ic tho ? v'* liiv u vywuaju&vsi ww hUui uiivw-vU) niuvu 10 uiw case in any war. We have become accustomed to low casualties following Grenada, Panama and the GuJf War, and the losses sustained in Bosnia will be high. But if we are to stop the further butchering of innocents and reclaim the mantle of leading the free world, then action must be taken before it is too late.