Koop Issues Call to Firms to Boost Child, Maternal Health Benefits

SAN FRANCISCO —  Warning that health care for mothers and children in the United States is inadequate and likely to get worse, U.S. Surgeon General Dr. C. Everett Koop said Monday that in the remaining months of his term in office he will try to persuade businesses to increase health-care benefits for employees.

What corporate America “has failed to realize” is that it is in part responsible for the shockingly high infant mortality rate in this country, which has put the United States behind 17 other industrialized nations in the delivery and care of newborn babies, Koop said.

Speaking to 7,000 physicians attending the annual meeting of the American Academy of Pediatrics here, Koop, who has been surgeon general for seven years, said he firmly endorses a recent report issued by the nonpartisan National Commission to Prevent Infant Mortality that called for “universal access to early maternal and pediatric care for all mothers and infants.”

Better Insurance Urged

Because the government cannot possibly be expected to pick up the entire tab for such care, the responsibility will have to fall to private employers, who should start offering their workers far more comprehensive insurance packages than are now available, Koop said. That means not only insurance for illness and catastrophic disease but parental leave policies for the birth of babies and the illness of children, as well as preventive “well-baby” care--coverage that is rarely offered even under the best corporate insurance plans.

“Today, of the more than 56 million American women of child-bearing age, roughly 16 to 44, almost 28 million of them are employed full-time in the American work force,” he said.

“In addition,” Koop said, “well over half of all mothers of small children--kids 3 years old or younger--are working full time. . . . On a day-to-day basis, it is now clearly the managements of business and industry who exercise the most crucial influence over the health of America’s mothers and children.”

Each year in the United States there are about 40,000 infant deaths that could have been prevented in many cases if the expectant mothers had only had adequate medical care in the first months of pregnancy, Koop said.

Moreover, the cost-effectiveness of preventive medicine has been well demonstrated in a variety of ways, said Dr. Richard Narkewicz, president of the American Academy of Pediatrics.

For every dollar spent on immunizations, Narkewicz said, the country saves $10 in unnecessary medical expenses, which is why routine doctor visits for infants are so important. Yet few insurance policies cover such visits.

Foresees a Worsening

What is even more alarming, Koop said, is that the problem of inadequate maternal and child health care is likely to get worse as children stop being the dominant population group in America.

“Five years ago, for example, 28% of the American population were children under age 18, while only 21% were adults over the age of 55,” said Koop, who was trained as a pediatrician as well as a surgeon.

“By the year 2010 . . . 24% of all Americans will be under the age of 18 (and) . . . 26% will be over the age of 55.”

Following right behind this demographic change will be a shift in health-planning resources so that the elderly, rather than the young, will get the lion’s share of the nation’s health resources, Koop said.

His colleagues in the leadership of the American Academy of Pediatrics have strongly endorsed many of his positions.

“There is a growing consensus in America that we are not devoting enough of our resources to children, and if it continues, our entire nation is at risk,” Narkewicz said.

Narkewicz attacked the current federal health-care effort as being both inadequate and a patchwork of overlapping and inconsistent policies and programs.

‘Need Centralized Focus’

“If you look at the federal children’s health programs--100 programs under six Cabinet posts and scattered among 15 agencies and 45 bureaus--it should be clear that we need a more cost-objective and centralized focus for children’s programs at the federal level,” Narkewicz said.

In an effort to revamp the federal effort, which has grown over decades, and to encourage better corporate insurance coverage, the academy will mount an aggressive public awareness campaign and develop over the coming months a “grand design” for a new comprehensive health-care financing system, Narkewicz said.

“To lend import to this project,” he said, “one only needs to know the United States is the only industrialized country--other than South Africa--without a national health program.”

Nearly 20 million or 20% of children under age 18 are without insurance protection and countless more are under-insured, Narkewicz said.

One assumes that it is the children of young, poor and uneducated families who are most likely to suffer, but that is not necessarily the case, Koop noted.

For example, Koop cited a recent study by the National Center for Health Statistics that turned up some revealing data on 10,000 infant deaths in nine Midwestern and New England states in 1982.

Discrepancies Noted

The mothers of all 10,000 infants who died had one thing in common: they were all at least 20 years old. But when it came to the race and education of the infants’ mothers, there were startling discrepancies.

Among the white women with less than a high school education, there were only 12 deaths per 1,000 live births. But among black women of the same age and the same schooling there were 28 deaths--twice the rate.

Among white women with college degrees, the mortality rate dropped to 7.9, but for black college-educated women it was 20.6--nearly three times the rate for their white peers.

“Why should this be so? Is it culture? Race? Is it genetic predispositions? Is it access? Cost? We don’t really know,” Koop said.

Studies need to explore such questions, Koop said, but the country needs to get on with its first order of business--that is to “get rid of any and all barriers to health care for each and every mother and child in America.”