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The theme of prevention applies just as forcefully to medicine. This year the U.S. will spend about $660 billion, or 12% of its GNP, on medical services, but only a tiny fraction of that will go toward prevention. For children the most basic requirement is inoculation, the surest way to spare a child -- and the health-care system -- the ravages of tuberculosis, polio, measles and whooping cough. During the first 20 years after the discovery of the measles vaccine, public-health experts estimate, more than $5 billion was saved in medical costs, not to mention countless lives. And yet these days in California, the nation's richest state, only half of California's two-year- olds are fully immunized. Dallas reported more than 2,400 measles cases from last December through July, eight of them fatal, including one child who lived within six blocks of an immunization clinic.
Even parents who recognize the importance of preventive care are having a harder time affording it for their children. Most Americans over age 65 are covered by Medicare, the federal health-insurance plan under which the elderly -- rich or poor -- are eligible for benefits. Children's health programs, in contrast, are subject to annual congressional whims and budget cutting. Fewer and fewer employers, even of well-paid professionals, provide health benefits that cover children for routine medical needs. This means that health costs are the responsibility of individual parents, who make do as best they can, often at considerable sacrifice.
Some states and community groups are trying to help. Two years ago, Minnesota pioneered the Children's Health Plan to provide primary preventive care for children. The plan costs the state about $180 per child, but parents pay only $25: in the end everyone saves. Schools in Independence, Mo., established a health-care package to provide drug and alcohol treatment and counseling services for every child in the district. Cost to parents: $10 per child. In Pittsburgh 12,000 children have received free health care through a program crafted by churches, civic groups, Blue Cross and Blue Shield.
But too many kids are denied such care, and that starts a chain reaction. "You can't educate a child unless all systems are go, i.e., brain cells, eyes, ears, etc.," says Rae Grad, executive director of the National Commission to Prevent Infant Mortality. A national survey in 1988 found that two-thirds of teachers reported "poor health" among children to be a learning problem. This is why Head Start, the model federal program providing quality preschool for poor children, also includes annual medical and dental screenings. But once again the money is not there: only about 20% of eligible children are fully served by the program.