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EFFORTS TO IMPROVE HEALTH CARE HAVE ONLY MADE THINGS WORSE

As a former director of public relations at Buffalo General Hospital and a former marketing manager at Blue Cross & Blue Shield of Western New York, I am familiar with government intervention in health care from the perspectives of both a provider and an insurer. I have seen how government's efforts to "fix" things usually make them worse -- for everyone.

As Congress struggles to come up with a Patient's Bill of Rights to control "abuses" by HMOs, I recall that it was Congress in the 1970s that spurred the development of HMOs by providing grants and loans of $375 million to start 500 of them.

Congress also told the HMOs to provide more preventive care, stop unnecessary and expensive emergency room visits, limit the tests and procedures done by doctors and shorten hospital stays. They forced employers of 25 or more to offer HMOs as alternatives to traditional insurance and told us we'd all be better off with managed care.

Now Congress wants HMOs to go in the opposite direction, by letting patients decide when they need emergency care and sue HMOs when the result of their care is less than what they think it should be. This will raise the cost of HMO coverage, but do little to improve it.

In the 1980s, Washington decided to reduce its Medicare spending by establishing specific numbers of days of hospital care it would authorize for each patient's diagnosis, regardless of how long the person was kept in the hospital. Since hospitals were already underpaid by Medicare, they soon figured out that they could recoup some of that lost revenue simply by sending Medicare patients home a day or two early. Thus, patients were sent home "quicker and sicker." This continues today.

This year, to reduce Medicare's nursing-home costs, Washington created a new $1,500 annual cap on speech and physical therapy after the first 100 days in a nursing home, thus forcing the homes to reduce care or lose money. The government has also forced nursing homes to perform much more paperwork to justify treatments for each Medicare patient, diverting nurses from patient care.

As to President Clinton's proposal to add a partial prescription drug benefit to everyone's Medicare coverage, this can't work because Clinton himself says that 90 percent of the Medicare enrollees would have to be willing to pay a $24 dollar-a-month increase in their Part B premium to make it viable.

Since two-thirds of Medicare enrollees already have better prescription drug coverage through employer or private plans, most would not pay for a government plan limited to 50 percent of prescriptions and $1,000 a year in benefits. Good prescription coverage for all Medicare enrollees would require a major tax increase.

Inevitably what happens when government takes over the provision of health care is that care becomes rationed. In 1965, before Medicare and Medicaid, Canada paid more of its gross domestic product on health care than we do.

Today, while covering all its people, Canada pays less, but it also provides poorer care. People wait much longer for all but emergency care, the latest diagnostic equipment is not nearly as available as in America and most provinces continue to cut their health-care programs back each year.

As to America's uninsured, fully one-third could afford insurance but don't want it and the rest can get insurance at reduced rates or walk into places like Buffalo General for top-quality care at reduced charges based on their income.

Our health-care system can use improvement, but the public should be leery of any government "solutions" because they likely will make our health care worse.

RICHARD TEETSEL lives in the Town of Tonawanda.
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