• Circle, underline or highlight the statistics. Make some comments about whether it is descriptive statistics or inferential statistics. Also, identify the population and the sample, if possible.

In the Congress, last week, the debate sharpened over the ways and means of spend ing new billions of dollars for the nation's medical care. Yet for a small but increas ingly vocal group of econo mists, sociologists and even physicians, the whole argu ment seemed somewhat be side the point. More doctors and hospital beds for the millions, they believe, will do little to reduce serious illness or prevent premature deaths.

Health leaders testifying before the Senate Health Sub committee were arguing the merits of four plans. Presi dent Nixon wants a national insurance program that will be paid for by the individual, his employer andin small partby Government. The American Medical Association has submitted a similar plan. Senator Edward Kennedy wants the Government to pay the bill. Senator Jacob Javits seeks to extend the present health insurance for the aged to everyone.

Under such programs, the diseasecare industry is likely to grow from its present $60 billion a year to $75billion or even $100billion, making it the biggest business in America. So far the major argument has been over the means of financinggovernment or privateand, peripherally, over ways of restructuring our medical panoply to provide care that is "better," less expensive and more evenly distributed.

But there is increasing evidence that the medical complex, no matter how re structured or paid for, may be irrelevant to the central health issue. Thus, for ex ample, Dr. Eli Ginzberg, Columbia University econo mist, points out that, "Despite the substantial increases in expenditures for medical care, there has been no significant increase in male longevity during the past decade." And Dr. Victor. Fuchs, another economist, comments: "My reading of the health litera ture leaves me with the im pression that the greatest potential for improving the health of the American people is not to be found in increas ing the number of physicians, or forcing them Into groups or even in increasing hospital productivity, but is to be found in what people do for themselves."

Both views depend on two selfevident axioms. First, the doctor is helpless before ailments that account for most of the sickness and death in Americaheart, kid ney and blood vessel ailments, cancer, alcohol and drug abuse, accidents and the gen eral debilitations of age. Even though he can cite, individual instances of spectacular cure or life saving, in general he palliates. He reaches the Pa tient with too much medical too late.

As a corollary, even when doctors get there early, the stastistics show little change. At least four studies have in dicated that annual physical checkups do not decrease mortality or morbidity.

A second axiom states that in the modern world, housing nutrition, accident preven tion, sanitationclean water, food, streets and homeshave produced more health than all the doctors and hospitals combined. Recognizing this, the Community Medicine De partment of Mount Sinai Hos pital is developing a corps of "super" superintendents to repair toilets, clean out rat and vermin infested base ments and maintain deterio rated housing in the slums. These men, it is felt, will pro duce more health than an equivalent number of doctors and nurses.

Dr. Nathan Glazer, the sociologist, argues further in the current issue of The Pub lic Interest that our personal, psychological and cultural milieui.e., the way we have learned to take care of our selvesmay be as Important as better environmental conditions and certainly more important than doctors and doctoring.

He points to a curious set of statistics: Sweden has 83 doctors per 100,000 popula tion but it has half the death rate among middleaged men as the United States, with 140 doctors per 100,000. Further more, Americans go to their doctors twice as often as Swedes do. Even within the United States, the wide vari ations of doctor availability do not seem to have any cor relation with health. Rather, health indexes seem more re lated to poverty levels within states than to numbers of doctors.

Many blame the current financial medical crisis on the inefficient system and they want to improve its efficiency so it delivers more medical care for the dollar. The KaiserPermanente Plan and the Health Insurance Plan of Greater New York (HIP), both prepaid insurance plans with doctors working in groups, are one approach to increased efficiency. President Nixon is pushing for establishment of such "health maintenance organizations." But though they can cite statistical evi dence showing lower death rates among their members than among users of other kinds of insurance plans, they have been unable to untangle those figures from social and economic patterns of their patients. Thus, maternal mor tality rates among blacks in the two plans are lower than those for blacks outside the plansbut higher than those for whites within the

If the critics are right, the new Insurance programs, if passed, will serve mainly to drive up demand for health carewhich will in turn drive up costs, there by consuming a substantial portion of our national talent and treasureand there will be little improvement in the mortality and morbidity sta tistics to show for it. The alternative: Put more effort into traditional areas of nu trition, housing and sanita tion, especially among the poor. And break new ground with nonmedical preventive measures campaigns for auto and home safety, massive anticigarette, antialcohol, antidrug programs, and high powered educational schemes to teach us to take care of ourselves.

EARL UBELL

Mr. Ubell is science editor of WCBSTV News.