America faces a health-care dilemma because the amount of money the nation spends on staying well is increasing yet Americans are not getting any healthier, the former governor of Colorado said Saturday.

Speaking at a seminar commemorating the 25th anniversary of the University of Utah Medical Center, Richard D. Lamm said Americans spend an estimated $560 billion on health care annually, approximately 12 percent of the gross national product, yet America is not as healthy as other nations that spend less. Lamm is the current director of the Center for Public Policy and Contemporary Issues at the University of Denver."Look at Japan and Taiwan - places where whole civilizations have type-A people working 70 hours a week. They have healthier people and spend less on health care," Lamm said.

This dichotomy is partly the fault of America's health professionals, but some of the blame lies with individuals. Two-thirds of all deaths before age 65 could be prevented. "Nations that provide basic health care to citizens have healthier people," Lamm said. "We ration people rather than health care."

Health-care costs increased rapidly after the U.S. started regulating costs, Lamm said. For example, towns with two hospitals have higher health-care costs than towns with one hospital. Costs in towns with many doctors will be higher than towns with fewer doctors.

In the same vein, Lamm said health maintenance organizations or HMOs will save particular clients money but studies say the money saved is cost-shifted in the region to another area, so money isn't really saved in the long run.

Reduced mortality came after the nation started spending more on health care. In just one year, the federal budget for Medicare and Medicaid increased 15 percent from $133 billion in 1989 to $153 billion in 1990. According to Lamm's figures, this is the highest increase in the federal budget including defense, Social Security and interest on the national debt.

Lamm said the United States has too many doctors, specialists, hospital beds and duplicated technology.

"There are 40,000 surplus doctors in the U.S.; after the year 2,000 there may be 200,000 surplus doctors," he said. "Sixty percent of the 50 largest metropolitan areas are operating under 70 percent of bed capacity and that includes Salt Lake City," he said.

Many of the people in hospital beds don't need to be there. They are there because their insurance allows it, he said.

Americans spend more on death, dying and defensive medicine than any other society. No other nation has such a variation between regions for the same medical procedure and no other society spends as much on high-tech medicine or the elderly than the United States, Lamm noted.

"No other society spends as much on bureaucracy and no nation produces as much paper per health transactions as we do," he said.



`Wellness' for health-care system

Former Colorado governor Richard D. Lamm suggests ways to improve U.S. health care: - Move from medical care to self care.

- Teach and encourage patients to be effective consumers.

- Educate Americans and be realistic about their expectations.

- Admit that we can't do everything for everybody.

- Stop training too many doctors and lawyers.

- Close hospitals, close beds in other hospitals, close some inten sive care units and regionalize high technology.

- Maximize generic drugs.

- Tax cigarettes and alcohol and push for a smoke-free society.

- Form hospices and promote immunizations.

- Pass living-will legislation.

- License paraprofessionals.

- Push for alternative delivery systems.