Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, August 1, 1994                   TAG: 9408010017
SECTION: EDITORIAL                    PAGE: A6   EDITION: METRO 
SOURCE: ROBERT B. FEILD
DATELINE:                                 LENGTH: Medium

CAN ANYONE BUT GOVERNMENT CONTROL HEALTH-CARE COSTS?

I've had four colonascopies over the past 10 years. The cost of the first one was approximately $400; the latest one cost more than $2,000. Several years ago, a retired surgeon told me of being shocked at the bill he received for a procedure that was 10 times what he had charged when he was practicing.

Therefore, I've followed current discussions dealing with the crisis in medical-care costs with interest. Much of what I've heard and read has been not about controlling costs, but about how to provide more care to more people, who shall control the supply of this care, and who shall pay for it. I don't remember hearing much, if any, discussion of reducing costs.

I've had occasion recently to receive some very thoughtful, concerned medical care from some very hard-working doctors in Roanoke. So it was with hope for a thoughtful, reasoned communication that I read the June 25 letter to the editor in the Roanoke Times & World-News, ``Some will wait, some will die, with health-care rationing'' by Newell R. Falkinburg, president of the Roanoke Valley Academy of Medicine. I was disappointed.

Most of his article dealt with rationing of medical care. This is a very emotional subject and is usually presented in a manner well calculated to arouse and terrify people. (While I was writing this, the insurance-industry commercial on rationing was on television.) It seems that medical-care rationing is nothing new. Receivers of medical care live with it all the time - in one form or another.

I awoke one morning recently, aching all over and with a temperature of 101 degrees. A call to my family doctor's office told me they could see me Thursday or I could go to the emergency room where I would eventually be seen by my family doctor, the only one available. I ``rationed'' myself and stayed in bed, taking aspirin.

People without insurance or money for a regular doctor are ``rationed'' to the care they can get at an emergency room. I observed this when my wife had a bad fall after doctor's hours and I took her to an emergency room. The four other patients were there pretty obviously for non-emergency care - stomach ache, colds or such. The real issue on rationing is: How are we, as a society, going to ration medical care?

Falkinburg says, ``the resources are there, a patient needs them, but cannot have them because of cost and/or availability.'' He blames high cost on government, the insurance industry, our lifestyle choices, and subordinately the high cost and overuse of technology. He makes no mention of the high cost of doctors, hospitals, laboratory services, medicines, etc., and medical liability insurance resulting from our legal system and the lawyers who operate it.

Falkinburg says, ``global budgeting (when the money is gone, you wait or die) is the tacit rationing of health care.'' To me, the proper concerns are how to provide the money to avoid waiting or dying, who is to get that money, and who is to control its distribution. I do not have clear answers to these questions, but I would make several observations.

Large industry provided me with excellent insurance for medical care. Small businesses paying none of the cost hardly seems fair.

Additional taxes have become anathema to the public and politicians. Taxes would be much more acceptable if politicians and government bureaucrats didn't waste so much. I would strongly object to giving more money to the existing system of technology providers, doctors, hospitals, laboratories, lawyers, etc., if all that happened was for medical costs to continue growing at several times the inflation rate.

But, from my perspective, medical-care providers and insurance companies haven't controlled costs. Price controls are notoriously inefficient.

As much as we know of government inefficiency and waste, it sometimes is the only alternative. When industry didn't safely dispose of toxic waste, government had to intervene. When the securities industry didn't stop fraudulent activities, the government again had to intervene. It well may be that since medical providers have not controlled costs, and don't seem fit to make care affordable for all, government may be the only alternative.

Robert B. Feild of Hot Springs is a retired chemical engineer who worked at Dupont in Wilmington, Del.