Interview

Article Abstract:

An interview concerning health care in the US is presented; it was with Senator Edward M. Kennedy, Democrat from Massachusetts and Senate member since 1962, and was conducted by The Journal of the American Dental Association. As prime health issues for congressional concern in the 1990s, Kennedy cites the large number of people without medical insurance; long-term care for the nation's elderly; AIDS and drug abuse; and diseases related to smoking. His solution to the insurance problem is a program that combines private and public coverage to meet the needs of the public. Elderly people are impoverished chiefly because they must spend their own funds for long-term care, a problem also faced by the disabled and those with AIDS. Senator Kennedy has introduced a bill to provide universal health insurance, called the Basic Health Benefits for All Americans Act. This could be phased in gradually without endangering planned budget deficit repair measures; it would depend heavily on coverage through private employment-based plans. Long-term coverage will require additional monies, which could be provided by eliminating the cap on wages that are subject to the Medicare payroll tax. The catastrophic benefits law was repealed by Congress because the law forced the elderly to bear the costs of long-term care themselves. Changes in Medicaid will be proposed by the National Governors Association. Kennedy favors a plan that builds upon the public-private system currently in place, rather than one providing universal coverage. The first step should be the provision of insurance to working people without coverage. Business, which is currently paying 45 percent of profits for health care, is strongly motivated to work with the public sector to keep costs down. The Kennedy Health Maintenance Organization legislation has been generally successful. While the system of delivery of dental care has succeeded in reducing costs and improving access to care, several factors (lower level of need for services, lack of use of hospital facilities) make it an inappropriate model for the medical care system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Medical care, Political aspects, Interview, Kennedy, Edward M.

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Immersion foot: a problem of the homeless in the 1990s

Article Abstract:

Immersion foot, more commonly known as trench foot, is becoming a common affliction of the homeless, and is caused by prolonged exposure of the feet to a moist, enclosed environment, as by wearing wet shoes for extended periods. Three cases of immersion foot are described. The first case is that of a 38-year-old homeless man who had been working in a meat-packing plant in canvas tennis shoes, which he did not remove when he slept. His feet were found to be swollen, red, and quite painful. Bedrest, air drying of his feet, and mild pain relievers resolved his symptoms within 48 hours. In the second case, a 75-year-old woman who continually wore her fur-lined bedroom slippers was found to have swollen, wrinkled, white feet. The third case was a 34-year-old homeless man whose feet were so painful he could not walk. They were found to be wrinkled, swollen and red. With air drying and an antibiotic, his feet were much improved in 24 hours. Immersion foot symptoms are caused by the ability of the thick soles of the feet to absorb large amounts of water, only some of which then passes into the circulation. When the water to which the feet are exposed is also cold, the circulation in the foot is impaired, posing a risk of nerve damage and even gangrene. The treatment of immersion foot is simple, in that bedrest, air drying and elevation of the feet will usually produce resolution of the symptoms in a relatively short time. Silicone grease, which prevents water from passing through the skin, is not commercially available, but could be prescribed. Given the increasing numbers of homeless people, immersion foot is likely to become an even more common problem than it is at present, and physicians must be aware of its symptoms, complications, and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, Homeless persons

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Expensive health care: a solvable problem?

Article Abstract:

A recent survey found that 91 percent of the people in the United States believe that everyone has the right to the best medical care possible. Sixty-six percent think it is unfair that some people can obtain better medical insurance than others, and 71 percent think that insurance should pay for all life-saving treatment, no matter what the cost. The same survey found that only 10 percent of the people would be willing to pay higher taxes to support better medical care. The dilemma is obvious; people are unwilling to lower their expectations of health care, and at the same time are not willing to accept its inherent cost. Is there any solution to this problem? While insurance companies, health care providers, and the government strive to economize wherever possible, it is clear that without the participation of the public, the necessary savings cannot be achieved. At least part of this participation must come in terms of accepting a balance of risks and benefits. For example, a new contrast material for X-rays is safer than the traditional material, but also more expensive. Its widespread use would cost an additional $1 billion for a few lives saved. Should it be introduced? At present, the courts seem to feel that anyone hurt by the old method is entitled to compensation from the physicians who chose not to use the newer material. The current opinion seems to be that when a better method exists, it must be used, regardless of the cost. There seems to be no alternative than for the public to acknowledge the realities of health care costs and to participate in the economies necessary to keep them in check. One way the public can do so is to adopt healthier lifestyles, for example by quitting smoking and reducing obesity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ethical aspects, Public opinion, Medical fees, editorial

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