Getting Too Much

IT FASCINATES ME listening "from afar" to the current debate about American health care reform--especially after practicing medicine for seven years in America and seven years in Africa. Gordon Bonnyman gives a good, though involved, review ("The Healing Game," June 1993) of half of the problem: The poor aren't getting enough health care. All of his assertions and proposals center around ways to expand coverage equitably while limiting spiraling costs "by reducing the income of the health and insurance industries and by lessening their control over the health care system." No argument.

But inequitable distribution is only half the problem. The other half is this: We're all getting too much. Ivan Illich proclaimed this in 1975 (Medical Nemesis: The Expropriation of Health) and it's even more true today. Aside from conscious attempts to "opt out," such as home birthing and herbal and spiritual "wholistic" medicine, technological Western medicine is spreading like a cancer. Western "standards" are very high and very costly--especially compared with Third World standards. Perhaps too high.

Bonnyman asserts that "health care is a human right," but doesn't tell us what standard that health care follows. A private hospital room with a telephone and television for every in-patient episode? A dollar-a-tablet antibiotic when one costing a few cents will do the job? Cosmetic surgery for all who are unhappy with the way they look? Intensive care for people with incurable conditions? Disposable everything (for sterility? or convenience?)? I wonder if the cost savings from a different, but adequate, standard could finance reasonable health care for all.