The $430-Dollar Question : A gloomy diagnosis for a sickly health-care system

After an 18-month study of America’s health-care system, a bipartisan commission concludes that it is “approaching a breaking point.� The nation will overlook--or play politics with--this gloomy diagnosis at its peril. Sen. John D. (Jay) Rockefeller IV (D-W.Va.), chairman of the commission, says that failure to improve health care could bring the United States to its knees.

The study group consisted of a dozen members of Congress and three medical experts appointed by former President Reagan, including a past president of the American Medical Assn.

As to the sometimes abysmal and often haphazard access to medical help in the United States, there was no dissent. The report drew criticism mainly on questions of how to change the system and where to find the estimated $72 billion a year that improving the system will cost.

There are shocks everywhere you look in the 315-page analysis. The number of Americans with no insurance of any kind to help pay for medical care now is up to 37 million. Another 60 million have some insurance, but not enough. What’s more, these are not people on the economic fringes. Three-fourths of them have jobs or are in families that earn income.

Another shock: Less than half of Americans with incomes below the official poverty level get medical help from either Medicaid or Medicare, the two immense federal programs for the elderly, the disabled or the poor.

A bare majority of commissioners, eight of 15, voted to require companies to provide health insurance for employees. The majority also wants minimum health standards for all Americans--including prenatal care--and a new system for the poor to replace Medicaid. These changes and a decent program of long-term care for the elderly would cost most American adults an extra $430 a year in taxes. The group also split over just how to raise the money.

But the nation has fair warning. Its leaders have no more important task than deciding how best to respond.