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With the increasing "turmoil brewing" in health care, there is no coordinated leadership to steer Utah's "ship of health" through the rising storm that threatens to inundate the system.

Major concerns by the score are combining to endanger the health care system:Costs are soaring (five times the inflation rate); 91 percent of a group of top executives (not benefits managers) agreed with the statement, "Health care costs are still very much out of control"; supply of nurses is seriously short; physicians are withdrawing from treating Medicaid patients because reimbursements are too low; hospitals protest that reimbursement for 40 percent of their patients (Medicare and Medicaid) is below their costs; private payers complain that they have to pay more because of cost shifting; hospitals are operating at only 60percent occupancy; many HMOs are in questionable financial condition; insurance companies argue they are losing money.

A quarter of a million people in Utah are without medical coverage; health care in rural areas is threatened; some are protesting that hospital beds are too much concentrated under one ownership; some patients can't get itemized statements from hospitals to check their charges; overuse of medical services is occurring because patients don't have to pay the bills; some providers may be inclined to do more than is necessary; costs of malpractice insurance continues to rise; ethical concerns exist about who should be allowed to die and when, and who should be kept alive and at what cost; employers are shifting more out-of-pocket costs for health directly to the employee; Congress is pondering more mandated benefits. The list goes on and on.

Normally, society has expected that either the economic marketplace or regulation would keep costs in line while resolving these problems. As of now, neither the marketplace nor regulation is working effectively, leaving costs to rise with limited restraints.

This situation has left the various parties - patients, providers, payers and policy-makers - squabbling to protect self-interests.

More energy and resources are being spent on self-defense against accusationsand pointing fingers at others as being the cost-culprits, and thwarting others'efforts to make a marketplace work, than on cooperating to solve the state's health problems.

Self-interest has fragmented leadership and resources. There has been no major concerted, effective effort to pull these desperate self-interest groups together to tackle confusion. Only small Band-Aidish steps have been taken to cope with a massive heart attack.

Now in January 1989, the New England Journal of Medicine has published three articles and one editorial, in effect saying a national health plan's time has come. Really!

One senses that the state's "ship of health" is at sea with a severe storm threatening and those on the quarter deck are each trying to grab the helm to steer to their perceived advantage. The passengers are at the mercy of a nonexistentleadership, while the ship is soon to be inundated with a storm and tidal wave.

Before it is too late (hopefully it is not already too late), some coordinated leadership constituted of the major players representing patients, providers, payers and policy-makers must be brought together to bring order out of chaos - to provide some clear captaincy for a ship about to be engulfed.

These should be a small number of leaders spurred by the urgency of the impending danger, creating a climate of cooperation with a strong inclination to be visionary and a desire to understand each point of view.

As the Atlanta Health Care Alliance pointed out last year: "The time has comefor top business leadership to challenge the hospitals and their medical staffs to get to work on tough, collaborative, community projects to reduce expenditures in an orderly way in the community interest - and do it now, before the meat ax falls and forces retrenchment in a period of financial crises when dangerous mistakes will be inevitable.

"This calls for business to use its clout not only with respect to health benefits, but also in the hospital board rooms where the basic decisions must be made."

Utah has the ingredients to set an example for other areas in demonstrating that cooperative statesmanlike leadership is possible. The state is small enough to be manageable, its borders are well enough defined to give it a spirit of community, and it has some cultural traditions born out of adversity that lend to its people a spirit of community and voluntary cooperation.

Oh, how we need a gentle giant in our community or better, a handful of gentle giants, to inspire us, pull us together, and show us the vision of what we canbecome in a gentle, efficient, health-caring way.

Before it is too late, before the ship is inundated, before crisis forces upon us actions of a meat-ax nature - who will step forward with the vision of whatwe can become? Who will join in making it so?