Opinion Extra

Kristof: Health care: Is the status quo what we want?

If you found a suspicious lump in your neck, you'd never put off dealing with it with the excuse: This is the loveliest neck in the world, and I don't want to tinker with it.

Sure, hospitals are expensive and serve tasteless food. Yes, surgeons can accidentally leave a clamp behind, and nobody likes blood. But burying one's head in the sand is what ostriches do - and that's what we Americans are poised to do if we miss this chance to reform our sick health care system.

The debate about health care in recent months has focused on the shortcomings of the reform proposals. Critics are right to be disappointed that the legislation doesn't curb malpractice suits and doesn't do more to change the basic fee-for-service structure that incubates rising health care costs.

But just think for a moment about the far costlier option that now may lie ahead of us: sticking with the status quo.

Health care is on my mind partly because my eldest son, a champion high school wrestler, had his latest post-match encounter with the medical system. You know you have a problem when the ER nurse immediately recognizes your son and discusses whether hospitals should give kids the equivalent of frequent flier miles.

Thirteen stitches and a serious infection crisis later, my son is on the mend. He had the help of an excellent, committed pair of doctors, his pediatrician and an oral surgeon. But for tens of millions of Americans who are uninsured or underinsured, medical care is haphazard and sometimes nonexistent.

And every indication is that the longer we stick with the existing system, the worse the problems will be with the two central and interlinked problems of our health care system: access and cost.

For a peek at what to expect, consider that California's Anthem Blue Cross and Blue Shield - the largest for-profit health insurance company in America's most populous state - is explaining that it is "sound and necessary" for it to raise rates for individual insurance by up to 39 percent. The increase, originally scheduled for March, is now scheduled to take effect in May.

Critics doubt that the Senate and House bills would succeed in containing health care costs very much, and they may be right. It's hard to know. But the existing system is a runaway roller coaster. Isn't it prudent to try brake pedals even if we're not sure how well they'll work?

The U.S. Public Interest Research Group calculated last year that without reform, insurance premiums for those with employer-provided health care would nearly double by 2016. Also last month, the Urban Institute applied its computer model of health insurance costs to a scenario in which there is no reform, and this is what it found:

"Over the next decade in every state, the percent of the population that is uninsured will increase, employer-sponsored coverage will continue to erode, spending on public programs will balloon, and individual and family out-of-pocket costs could increase by more than 35 percent," it said. It added that the number of uninsured Americans could reach as many as 65 million in another decade.

And The New England Journal of Medicine noted last month that the United States ranks No. 1 only in terms of spending. We rank 39th in infant mortality, 43rd in adult female mortality and 42nd in adult male mortality.

Skeptics suggest that America's poor health statistics are a result of social inequities and a large underclass. There's something to that. But despite these problems, the population over age 65 manages to enjoy above-average health statistics - because it enjoyed health care reform back in 1965 with Medicare.

The medical journal noted that "comparisons also reveal that the United States is falling farther behind" other countries each year. In 1974, for example, Australian men and boys aged 15 to 60 died at about the same rate as American men and boys in that age group. Today, Australia's rates for that group are about 40 percent lower than America's.

"U.S. performance not only is poor at any given moment but also is improving much more slowly than that of other countries over time," the medical journal reported.

So don't believe the canard that health reform is unaffordable. Last year, we spent 17.3 percent of gross domestic product on health care, about double what many other industrialized countries pay. The share is rising by more than one-quarter of a percentage point per year.

At the present rate, by my calculations, in the year 2303 every penny of our GDP will go to health care. At that time, we'll probably get daily M.R.I.'s and CAT scans, even as we starve naked in caves.

So the question isn't: Can we afford to reform health care? Rather: Can we afford not to?