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Health Care Debate: Who Will Pay the Way?

August 30, 1987|ALLAN PARACHINI | Times Staff Writer

Bryan Redfield gets up from a kitchen chair slowly, awkwardly using his arms to help maneuver his partially immobilized lower limbs, the result of a horribly broken pelvis suffered in a car crash.

With a severe limp, he propels himself into the living room of the tiny West Hollywood apartment where he lives alone, struggling past a set of braces and a pair of aluminum crutches discarded haphazardly on the floor next to a physical therapy table until he reaches a plastic shopping bag stuffed nearly full with hospital and doctor bills.

The bills are a result of the Dec. 6 accident, in which Redfield's car was broadsided by a drunken, uninsured driver. Redfield escaped with scars no higher than the unmistakable tracheotomy on his throat, but he suffered such massive internal injuries that he needed more than 100 units of blood, spent seven months in three hospitals and is only now learning how to walk again.

Rummaging through the bag with a slight, ironic smile, he finds what he is looking for: a single yellow sheet sent him at Rancho Los Amigos Hospital, from which he was discharged in June. The sheet is from Hollywood Presbyterian Medical Center, where he was a patient for more than a month after the crash. It says:

"This is to notify you that you still have an outstanding balance of $165,737.41. As a convenience to you, payment of the balance can be made by cash payment, check or by use of your Visa or Mastercard."

There is not much Redfield can do about this except laugh. A sporadically employed actor before his accident, Redfield was earning less than the $2,900 annual minimum to qualify for Screen Actors Guild health insurance. The tavern where he bartended offered coverage to its workers only if they paid for it themselves. But Redfield, 36, and otherwise healthy, couldn't afford the $90 monthly premium.

In all, he is a classic example of someone who has fallen--crashed might be a better word--through the cracks of the American health care delivery system. In part because of uninsured and under-insured people like Redfield--as many as 60 million others nationwide, by some estimates--a discussion suspended some time late in the 1970s has quietly resumed.

The topic: national health insurance, a concept sporadically bastardized and discredited for decades in the United States, where its opponents have equated it with "socialized medicine." The idea has emerged and disappeared from public policy debate on at least half a dozen occasions in the last 75 years. Bumper stickers have warned: "If you like the U.S. Postal Service, you'll love national health insurance."

There are signs all this may be changing:

- Intense economic pressures on the health care system--brought on by the AIDS crisis, a nationwide nursing shortage and a fundamental shift in the American employment profile--could make a nationalized program an unavoidable alternative to economic collapse of the existing system.

- There is growing concern among health economists and policy experts with the number of people who either have no insurance or grossly inadequate insurance, a number that may be larger than previously known.

- A new public opinion poll conducted for The Times finds that, despite conservative drift in the 1980s, a federally run national health insurance remains a concept supported by nearly two out of three Americans.

This resumption of the debate has not, thus far, propelled national health insurance to the top of anyone's list of urgent items for the American agenda. By and large, politicians are not yet involved; the issue has not become that critical. Yet a cadre of experts on the nation's health care system is slowly coming to the position that some kind of national health insurance plan--one that will significantly alter the way the average American receives his or her medical care--is almost inevitable by the turn of the century, and more likely by the mid-1990s.

Dr. Paul Ellwood, the Minneapolis-based architect of the movement toward prepaid care in health maintenance organizations, has always been identified as a conservative who opposes the type of government intrusion fundamental to national health insurance. Today, he says the concept appears to have a certain inevitability.

What's changed his thinking, Ellwood says, is a perception that it is now possible to fashion a national health insurance system that would take advantage of innovative new ways of providing and financing care. The process, he added, has been hastened by altered demographics of American society in which an aging population is being forced to come to grips with providing health care for everyone, not just the elderly and poor.

"The constituency is different now," he said. "It's much older. There's also the AIDS plague, the question of whether that, too, creates a reason for having national health insurance.

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