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At the turn of the millennium it is prudent to take a snapshot of health insurance in the United States and report on it. According to the United States Census Bureau the population of the country, as of July 1, 1999 was 274 million. The number of Americans without health insurance is now over 44 million. A recent study by the non-profit New York based Commonwealth Fund has found that even those individuals with health insurance very often are experiencing increased premiums for coverage which may have serious deficiencies regarding prescription drugs or preventive care. Richard Wade, Vice-President of the American Hospital Association points out that in today's economy large numbers of new jobs are being created, but fewer of them are associated with health benefits ( Lagnado L: Health Insurance Called Often Inadequate, The Wall Street Journal, December 30, 1999). The health insurance industry in the United States seems to have only one unified approach to this problem, this is to continue to increase premiums and to decrease service. If the present national health care debate is any indication of future governmental direction it is likely that a socialized health care system will be recommended to "rescue the public" interest. On the basis of this a "D" report card is being given to both these houses. To demphasize preventive care and to continue to deincentivize the public from taking a leadership role in their personal health future is unforgivable folly. To provide workers with starter health savings account-type opportunities at the new millennium makes sense. This must also be accompanied by education and instruction directed to individuals just how to access health information and become discerning consumers. With 50% of American households now possessing computers and 25% of American families on the Internet reasonable ability to obtain independent information now exists. Should there be a governmental desire to establish a truly democratic "level playing field" for the public against the deep (only for the moment) pocket managed care lobbying effort referendums can be held. If the United States government wishes to continue to maintain its outmoded and non-competitive Veteran Administration system it would do better to give veterans "chits" for care at the community medical facilities of their choice and turn the V. A. hospitals and centers into government sponsored free care facilities for infants and the elderly suffering from chronic and terminal diseases. Another, most appropriate, measure would be to reward the youth of the United States for their good fortune in being Americans by requiring two years of government service after completion of high school. In addition to many of the tasks which would contribute to the health and well-being of the country becoming aides at government facilities providing infant and nursing home type care would be a most important endeavor. Statistics show that 30% of an individual's lifetime medical costs usually occur in the last few months of their lives. Continuing medical care is often imposed against the individual's wish to be able to end their suffering and depart from their fulfilled life with dignity. No, most physicians do not really wish to be the vehicles by which this service is provided but they generally agree that a legitimate societal mechanism allowing for it is needed and would be appreciated. The situation right now does not give one a good feeling. We seem to be traveling in a high-speed train heading toward a river where the bridge is out and not only are we ignoring the flashing red lights we are increasing speed.
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