Rockefeller and Health


Washington.--Many have noted the oddity of Sen. Jay Rockefeller, member of a rich (and Republican) family representing a poor and Democratic state, but oddity is not new to West Virginia. The state was created in an act of semi-secession to help win the war against secession. It was cobbled together in 1863 from some Virginia counties that had few slaves or Confederate sympathies.

The Civil War ended slave power and unleashed industrialism fueled by a form of power West Virginia has plenty of: coal. Extraction industries are usually dangerous and unrewarding to the people who do the extracting. Small wonder health care -- its availability and cost -- is an old worry in a state where not long ago one-fifth of the families contained miners. Mr. Rockefeller is a prime mover behind the Democrats' new plan to contain health-care costs and broaden access.

The plan's most controversial provision is suited to a dry fiscal season: the government would mandate private-sector spending. Employers would be required to provide health-care coverage or pay into a fund that would finance coverage. The plan's radical potential is in its nuances -- the formulation of standards, medical and administrative, concerning the proper use and pricing of particular medical procedures.

The subject of health care is a migraine-inducing soup of acronyms, polysyllabic scientific terms and dollar figures containing three commas. Mr. Rockefeller is so marinated in the details, he sometimes turns this subject of national anxiety into an anesthetic, numbing the senses with numbers. It is as though he feels the need to prove that he is intelligent enough to have earned the eminence to which he was born.

He is; and no one is born into elective office. Think of him as an upwardly mobile poverty worker.

Before Mr. Rockefeller, now 54, was governor and senator, he was a Vista volunteer in a West Virginia village of 256 people where there were teen-agers whose teeth were half gone, so scarce was adequate dental care. The first time he got a pap smear van to come to town, no woman visited it. The second time was the same. After leafletting and other advertisements, a few women came for the van's third appearance.

Why would people not avail themselves of what was made available? Life, Mr. Rockefeller says, has been so hard in the hollows of his mountainous state, people are reluctant to risk learning more bad news.

So a teen-ager may not learn she is pregnant until her second trimester and may never get proper prenatal care. Just $500 worth of such care substantially reduces the risk of low birth weight requiring neonatal intensive care.

Such care costs $2,500 a day (as in Chicago's Cook County Hospital), or between $5,000 and $10,000 a day in even more technologically armed hospitals. Such care often lasts for two to three months.

You do the math. And don't forget the cost to society of coping with the consequences of permanent cognitive impairment -- welfare, special education, prisons.

The population is aging, medical technology is becoming more sophisticated and expensive, and malpractice litigation is provoking defensive medicine. (Perhaps 30 percent of health-care costs result from unnecessary or inappropriate procedures, but at least lawyers are confounded and machines are amortized). All of this takes an enormous toll on the competitiveness of American industry, which is paying much of the bill.

The health-care crisis is optional in the sense that it is rooted in foolish, modifiable behavior. Human beings are the only animals that eat, smoke, drink, drive and use drugs recklessly, and don't exercise naturally. And the composition of the medical profession -- too many expensive specialists; not enough primary-care physicians practicing preventive medicine -- reflects the perverse incentives of a disease-oriented, hospital-centered, high-technology health care system.

Mr. Rockefeller's subject these days is health care, but his nascent theme is general negligence. Occasionally the aridness of his utterances is irrigated by passion, as when he says Republican "inattention" -- the word bites, as studied understatement can -- to the nation's domestic problems is a "scandal." President Bush, he says, has "his head in Kuwait."

Mr. Rockefeller says, with a refreshing absence of folderol, "I want to be president." Before his family vacation in August, he will decide whether to run in 1992.

Today the Democrats' health plan seems like just another big program hard to understand and impossible to pay for. But if Mr. Rockefeller can put health care into a larger context, as Ronald Reagan made tax cuts serve a larger theme, he might make 1992 interesting. My wager is that he will.

George Will is a syndicated columnist. Ernest B. Furgurson, whose column usually appears in this space, is on vacation.

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