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Ralph Nader > In the Public Interest > Health Showdown Seen

General Motors complains that it pays more for health insurance than for steel.

Blue Cross is placing advertise­ments around the country pointing out the costs of surplus hospital beds, unnecessary surgery, facility dupli­cation and other wasteful practices that are sending hospital bills soar­ing. Blue Cross predicts that hospital stays could reach an average price of $450 a day in New York by 1980. Rep. Charles A. Vanik (D-Ohio) refers to Social Security information which he says shows that even with Medicare “older Americans are pay­ing more for health care now than be­fore Medicare” ten years ago.

WHEN WILL the breaking point come in this health price spiral? Will national health insurance simply aggravate the seemingly endless climb of hospital and doctor bills?

These are important questions. But they are seen by the health care busi­ness as more worrisome than pro­vocative of basic solutions. Ameri­cans are paying directly and indirectly to this industry almost as much as they are spending for food. It should logically follow that they should be prepared to expend some consumer effort next year to make sure the congressional debate on health insurance goes their way.

There is little doubt that the organ­ized voice of the drug industry, the medical profession and the health insurance industry will be heard on Capitol Hill. Most of these groups are willing to tolerate a bigger Uncle Sugar Daddy in Washington doling out more billions for waste, malprac­tice and corruption in the health industry.

The patient-consumer has different priorities. Any national health insur­ance proposal that benefits consum­ers must exert cost and quality con­trol and advance broader availability of health services and preventive medicine. This will not be achieved simply by a reinforced auditing effort by the federal government — how­ever necessary the corruption of Medicare and Medicaid has shown more auditing and law enforcement to be.

WHAT IS REQUIRED is a funda­mental rethinking of the health care delivery system which will put the consumer in the driver’s seat.

There need to be consumer advoca­cy groups established throughout the country through a voluntary check-off system on health insurance plans or policies. In this way, consumers can make voluntary contributions to their own state-wide consumer action groups whose full time staff would be able to fight for lower health care prices and higher health care quality. In addition, there needs to be greater consumer control of community health care facilities — from hospi­tals to clinics. The proper develop­ment of health maintenance organiza­tions and local health planning institutions could be a vehicle for this consumer role. Cooperatively owned medical services at the community level can be a major solution to the health care crisis and its indifference to comprehensive preventive medi­cine.

Recognition of the need for consum­er sovereignty has been emerging in small ways. Pennsylvania Health Secretary Doctor Leonard Bachman is seeking legislation to put the con­trol of Blue Shield in the hands of “consumers” and end physician con­trol of the pre-paid medical insurance system.

Consumer advocates are pushing in a number of states for genuine sub­scriber elections of Blue Cross boards of directors. Consumers, not hospital officials, bankers, and physicians, should dominate the boards of direc­tors of Blue Cross plans.

The time for cost control gestures is over. It is time now for consumers to organize their interests before the health insurance policies are set in granite for another quarter century.