Radical Surgery:: What's Next for America's Health Care

Noting that only three cents of every health care dollar goes to preventive measures, Califano urges massive governmental, business and community efforts to promote good health in this thought-provoking blueprint for overhaul of the nation's health care system. Drawing on his experience as secretary of health, education and welfare under the Carter administration, architect of Medicare and Medicaid under Johnson, chair of Chrysler's health care committee and president of Columbia University's Center on Addiction and Substance Abuse, Califano urges Americans to mount an all-fronts attack on abuse and addiction involving nicotine, alcohol and other drugs. He urges timely preventive care, particularly for pregnant women, babies, children and the elderly, as well as a coordinated attack on activities that send medical costs skyrocketing-reckless driving, air and water pollution, poor diet, violent crime, toxic lead-filled paint, teenage pregnancy and behavior contributing to sexually transmitted diseases.Califano's proposals are certain to stir controversy. Calling for an end to doctor's medical monopoly, he recommends an expanded role for physician assistants, nurses and midwives, as well as incentives for specialists to use costly tests and treatments only when absolutely necessary. His carrot-and-stick approach envisions company bonuses for healthy employees and insurance penalties for those who fail to pursue healthy habits. Charging that Congress, beholden to health industry lobbyists, has thwarted viable cost-cutting reforms, the author sketches a ``clean and lean'' plan to phase in affordable, universal medical insurance by combining government-mandated employers' benefits packages with the extension of Medicare to the poor and unemployed. (Jan.)