Seven ideas for getting there:

* Preventive medicine through personal responsibility. Within a
decade, a combination of good health habits and home health care could
reduce the total number of hospital days by 20 percent. That would
save substantially more money than the bureaucratic controls we are
moving toward.

We must shape a vision of personal responsibility, so that people take
care of themselves by watching their diets and habits. We may want to
reward people who do not need health care.

For instance, we could simply offer a $500 year-end bonus to people
who have not used Medicare during the year. This would make it
worthwhile for citizens to pay up to $500 on their own care instead of
using the Medicare system. The long-term effect of rewarding people
for watching their health, taking care of themselves, and being
responsible for minor health costs would more than pay for such a
year-end bonus.

We must bring physical education teachers, recreation program
directors, and health spa staffers into the process of developing
sound public health. Every citizen who avoids a heart attack saves the
community money. Every month that people can live in their own homes
because they are physically and mentally in good shape saves us
thousands of dollars in nursing home bills. Incentives for
participation in physical fitness programs, especially for people over
40, would probably pay for themselves.

Finally, we should establish a more direct relationship between bad
health habits and the cost of those habits to society. At present
nondrinkers pay for alcoholism clinics and nonsmokers subsidize the
hospital costs of treating lung cancer. A health tax on the alcohol
and tobacco industries would begin to recoup the costs they impose on
society at large and would have two beneficial side effects: We would
marginally discourage alcohol and tobacco abuse, and we would
encourage people to watch what they drink and smoke.

When people learn that their habits have a lot to do with their
health, and when they view health spas and recreation departments as
their allies in the effort to stay healthy all their lives, we will
have a more positive nation, more active senior citizens, and a less
used, less expensive health care system.