The Courier-Journal from Louisville, Kentucky • Page 51

The Courier-Journal, Sunday morning, February 3, 1980 Analysis Opinion Forum Books Kennedy has failed to exploit changes! in delegate selection A aW Ill lUr Health in the 1 980s More doctors, higher costs and an older population -a 4Vfc tutes of Health, the largest financier of such endeavors, spending $3.5 billion yearly. Dr. Donald S. Frederickson, director of the institutes, said studies of how cells are transformed from normal to cancerous have reached "a new stage of refinement" and this decade may be the one in which an understanding of that process is finally achieved. Of course, even if this were achieved, it is not known whether man could interrupt the transformation process.

New vaccines against formerly in-tractible kinds of viruses seem likely, he said. Scientists are mapping certain places in the brain that attract pain-killing narcotics. If the brain has such sites, this suggests there must be natural body substances that do much the same thing as narcotics. By discovering these natural substances, new pain-killing drugs can be developed that have the effect of narcotics, without being addictive, Frederickson said. One of the most exciting advances is in the splicing of genes so called recombinant DNA research.

In the 1970s, some scientists feared that splicing genes of one life form with another life form might create biological monsters for example, a deadly bacteria for which the human race has no defense. But with strict guidelines, progress in this area already is bearing fruit, Frederickson said. The Indianapolis-based Eli Lilly for example, is experimenting with splicing genes to come up with bacteria that produce insulin. Last month, there was the exciting announcement that scientists had succeeded in splicing human and bacteria genes to enable the bacteria to produce a form of interferon. Interferon is a natural body substance that combats virus infections and may help stop the spread of cancer.

But it has been difficult and expensive to make artificially. By ROBERT L. PEIRCE Caurlar-Journal Staff Writer WASHINGTON The forecast for health care in the 1980s is partly cloudy with a chance of rain. There will be moments of sunshine: Insulin and virus-fighting miracle substances will be manufactured by bacteria that have human genes. Because of a surplus of doctors, small towns will no longer have to beg for one.

Physicians will be writing articles about how they got good results by using fewer not more tubes and tests. On the other hand: Cigarette smoking will be a critical hazard to women, interferring with their natural biological superiority over men. Our society will continue to get older on the average as the progeny of the post-World War II baby boom near middle age, bringing on new health problems. And the poor will see their rights to health care, gained during the 1970s, begin to erode as government desperately tries to control costs. These were some of the predictions as leaders of government, academia and special-interest groups sat down with journalists at a four-day Washington seminar on the future of health.

Predictably, there were prophecies of new miracles to be wrought by the ever-more-sophisticated machines of medicine. But this time there was also an underlying pessimism much of it grounded in concern over the economy. Whereas in 1965 health care took up 6.2 per cent of the nation's Gross National Product, it now gobbles up 9.1 per cent and is eager for more. There seemed to be uncertainty about the future. Said one scholar at the seminar: "I know the country will be much different 10 years from now.

But I don't know whether it will be better off or worse off." In the early 1970s, most people thought comprehensive national health insurance was not a matter of if, but when. But no one at the health seminar was predicting such an event; a limited national insurance for catastrophic illness seemed the most likely possibility, if there will be any plan at all. Moreover, Dr. Robert J. Blendon, vice president for the Robert Wood WASHINGTON When John F.

Kennedy won the Democratic presidential nomination in 1960, big primary-election victories over Sen. Hubert Humphrey in West Virginia and Wis-, consin essentially made it possible. Twenty years later we have another Kennedy running for president. Setting aside the personal differences between brothers John and Ted Kennedy, the changes in the Democratic selection machinery during that time have been immense. And so far Sen.

Kennedy and his highly touted political advisers seemingly haven't mastered the psychology of the new system. In contrast, President Jimmy Carter is the experienced political pro. A little-mentioned key to this year's Democratic scramble in 35 presidential primaries and a handful of caucus states is "proportionate representation." What that means is that the Democratic Party, for the first time, requires each state to allocate delegates proportionately on the basis of primary or caucus results. The winner-take-all primary of the 1960s and 1970s is out at least this year. The new system should place much more Importance on the accumulation of delegates and less significance on who wins or loses the popular vote in any state.

For example, while Carter defeated Kennedy by a resounding 2-to-l margin in the Iowa precinct caucuses, the projected national delegate count gave Carter 30 delegates and Kennedy 15. For Kennedy, that's no victory, but it is a beginning. Not one of the 35 primaries has yet been held, and there are several more caucus states. But Kennedy is perceived as being on the ropes, about to be eliminated by Carter before the long primary process really begins. Much of this perception was brought on by Kennedy himself.

"Expectations" has become the 1980 political cliche, and the Kennedy camp early-on raised expectations for the senator's campaign in Iowa far beyond what they should have been. The logical objective for both Carter and Kennedy was to avoid looking like a big loser and to steadily pick up delegates. Thus, in the psychological warfare, each candidacy would remain viable for the long-haul goal of winning a majority of delegates by this summer's New York convention. Even if the Iranian and Afghanistan crises hadn't come along to boost Carter's political stock, the Kennedy camp should have played the delegate game much less flamboyantly. In pre-hostage days last October, the draft-Kennedy supporters in Florida predicted a victory over Carter in a meaningless county-caucus ballot.

They lost. That should have told Kennedy something about the battle ahead. But n-c-o-o-o. The senator quickly downplayed the Florida episode and an nounced that "the first real test" was Iowa, sounding distinctly as if he meant to whip Carter there. Then came the rally-round-the-flag days as the president took on the cloak of leadership.

Kennedy also military emits running to enlist in reserve units, which were 'then brimming with talent. The new armed services, a concept vehemently defended by the Carter administration against all draft-related schemes until Jan. 23, when Carter called for resumption of the draft registration, is a much different military animal. The Army is perhaps the best example of the changes that have occurred since the all-volunteer experiment took hold in 1973. That year there were 801,900 men in the Army and 758,000 in the Independent Ready Reserves.

Today the numbers are 765,602 in the Army roughly two combat divisions less and 209,000 in the Independent Ready Reserves, many of them cooks, clerks and other specialists. The differences between the two armies go much deeper than that. The 1973 Army roughly mirrored the demographic characteristics in the United States. It included college students and sons of the middle- and upper-middle class who had been drafted during the Vietnam War. In the enlisted ranks, 18 percent were black and 2 percent were women.

The 1980 all-volunteer Army now draws heavily on the lower-middle class and the poor. The percentage of blacks in the enlisted ranks has almost doubled, and the percentage of women has quadrupled. Among combat units, some of which now include women, the demographic characteristics are even less reflective of the nation as a whole. Acco'r in in is call of paid Analysis by Ed Ryan Courier-Journal Washington bureau chief badly underestimated Carter's ability to organize Iowa for the caucuses. After all, that was Carter country in 1976.

So when Carter humiliated Kennedy in the popular vote, no one cared much that in losing, the senator picked up 15 national delegates from Iowa. Amazingly, a few days later, Kennedy said he must win the Maine caucus on Feb. 10 and the New Hampshire primary on Feb. 26 to stay in the race. Understandably, he backed off later, but the damage was done.

The media hounds and the Carter people are likely to try to hold him to this high standard. Maine has 22 delegates. New Hampshire has 19. (Iowa has 50 delegates, with about five uncommitted.) There will be 3,331 total delegates at the New York convention. In this quickly changing world, events over which Carter has little or no control could cause the president's current popularity to nose-dive as fast as it soared.

Those unpredictable events could occur before the March 18 primary in Illinois, where 179 delegates are up for grabs; or April 1 and Wisconsin (75 delegates); or April 22 and Pennsylvania (185 delegates); or April 29 and New York (282 delegates). Then, on May 20, there's the Michigan primary (141 delegates), and on June 3 there is California (306), Ohio (161) and New Jersey (113). That's a lot of delegates to be had in places where a turn of events could make Kennedy more popular than he seems to be at the moment. Yet largely because of his own doing, the senator seems to be on the verge of going down the tubes after two small-state caucuses and one small-state primary. Tim Kraft, Carter's national campaign manager, shook his head in wonderment during an interview last week as he pondered the Kennedy campaign.

Kraft, who knows Iowa better than perhaps any national political opera-' tive, said Kennedy should have realized the natural problems he would encounter in winning Iowa. So, according to Kraft, the senator should have lowered his "expectations" drastically, down-played his chances, and taken his delegates and run. But Kraft isn't complaining. In fact, he was smiling broadly as he looked forward to Maine and New Hampshire. There's a lot of difference between the days of John Kennedy and Ted Kennedy.

But the proportionate requirements should help Ted Kennedy in his underdog role this year. muscle? ing to the Army, 50 percent of those in many front-line combat units are now blacks. Officers who have held commands both armies, including those who have recently returned from service NATO, say that the morale and the fighting ability of the 1980 Army is as good and some argue it may even better than the 1973 Army. They worry, however, about two problems that the 1973 Army did not have to face. An intense war against a major, high-power army such as the Soviet Union's would result in enormous casualties during the first engagements.

That means that 50 percent of the casualties would probably be black. Thus the cost in grief and human suffering of an all-volunteer rapid-deployment force would largely be borne by one ethnic group. What this means in terms of a political reaction one of the unknowns defense analysts can only wonder about Once these casualties were sustained, they could not easily be replaced. Unlike 1973, the nation no longer has a large body of young, trained men to compensate for the losses of front-line units. Current plans, revealed in a government-wide mobilization exercise called Nifty Nugget, required a up of military retirees, many of whom are in their 40s and 50s.

Most them are men who have already their "dues" in Vietnam. In order to fight and win against See WHERE PAGE 4, Column 1, this section By Stiff Artist Mlkt CovlngtM Some encouraging advances in health also seem to be occurring with no one knowing exactly why. The rates of death from heart disease have been declining for several years. The decline is steeper in this country than in countries of similar lifestyle, such as Great Britain. Because the heart attack itself is not a reportable disease, no one knows whether the actual number of heart attacks is decreasing, or whether it is simply the number of heart-attack deaths that are declining, Frederickson said.

For this reason, no one knows bow important changing the diet, controlling high blood pressure and changing lifestyles have been in reducing the deaths. Better treatment of heart-attack victims may be responsible. Probably, it is a combination of both, Frederickson said. Doctors A significant change is occurring in the number of doctors in this country. In I960 there were 148 doctors per 100,000 persons.

By the middle 1980s, there will be 225 per 100,000. This probably will bring on several changes, including a decline in federal support for medical schools, as lawmakers perceive that the money should be spent for more pressing problems. "We will see the last mention of a doctor shortage in American history," said Blendon of the Robert Wood Johnson Foundation. Though doctors will be reluctant to leave the urban areas, they will have no choice but to go to the smaller towns to make a living, he said. Crowing old Probably the most significant population trend in this country is that we See HEALTH PAGE 4, Column 1, this section 765,602 Staff Chart Johnson Foundation that helps foster health care for the poor, said there is a strong possibility that state governments will make fewer people eligible for Medicaid as the pressure of medical costs mount.

Paid for by both federal and state dollars and run by the state, these programs have been the major source of public health-care financing for the poor since 1966. Over the last few years, Medicare also has cut back on what it will pay. Harvard University economist Ra-shi Fein, an advocate of national health insurance, said people are angry at government and its regulations. They are developing the attitude of "times are tough, leave me alone," he said, and many believe "Social programs don't work, they 'are expensive and are aimed at people I don't have time for." "People no longer believe things are going to get better," Fein said. "They are scared." Most polls show people are generally satisfied with health care, they just think it costs too much.

So congressmen who walk away from national health insurance will not face the wrath of the people, Fein said. The people will reserve that for hospitals that raise their prices or health-insurance companies that increase their premiums. If the congressman votes for national insurance, on the other hand, he will likely have to go back to the people in a couple of years for a premium or tax increase, the economist said. And then the public anger will be directed at the lawmaker. Fein said he could conceive of the possibility of comprehensive national health insurance only if Sen.

Edward M. Kennedy, a long-time advocate of national health insurance, is elected president. Here's a closer look at what's expected in the health-care field: Research Medical research, of course, marches on, with the National Insti hardware for the Pentagon's brand-new deployment force into battle are specially designed cargo carriers with reinforced floors to carry tanks and doors that allow them to roll on and roll off in ports with little in the way of unloading facilities. These ships are still in the argument stage between the Navy, the White House and Capitol Hill. The money to buy the first two is in the new 1981 budget.

The rapid deployment force will require 15 of them. At the moment most of the Pentagon's plans for a sealift assume a North Atlantic Treaty Organization conflict in Europe and rely to a large extent on foreign shipping. Vice Adm. Kent J. Carroll, director of logistics for the Joint Chiefs of Staff, recently explained the situation before a House committee.

He said that it is "questionable" whether the Navy could currently find enough cargo ships to carry the rapid deployment force to the Persian Gulf. According to the current U.S. NATO commander, Gen. Bernard Rogers, the best Army to deploy in a rapid mobilization for a large-scale war should be one that is backed with at least 700,000 skilled combat soldiers in a reserve entity called the Independent Ready Reserve. Its function is to replace casualties and to round out army units, most of which are now under full strength.

The Army that can do what Rogers wants has not existed since the end of the draft. One of the prime functions of the draft in the Vietnam and Korean eras was to send potential Army re- Question: Where is our Middle East SINCE THE ARMY BECAME VOLUNTEER 1973 V- Independent Ready Reserves: 758,000 In the Army: 801,900 By JOHN J. FIALK Washington Star Sarvic WASHINGTON President Carter's sudden, dramatic call for the nation to prepare itself for the possibility of deploying a substantial military force to the Middle East has exposed a "reality gap," one that could p.ague military planners and politicians for months, probably years, to come. While the rhetoric, and perhaps the national will, to stand up to the Soviet Union is now in place, the "best" military hardware and the "best" manpower and readiness policies needed to accomplish this are still on the drawing boards. And for some of those items, the ink is hardly dry.

Some examples: The best U.S. transport aircraft for rapidly projecting military force into a remote, undeveloped region of the world is called the CX. It is designed to carry heavy battle tanks and a variety of other large military cargoes long distances and to operate on short, primitive runways. At the moment it exists only in the minds of aircraft experts who are discussing various schemes for the plane behind closed doors in the Pentagon. The first budget money for the plane is being proposed this year, and development will take several years.

Its predessor, the C-5, has a variety of problems. The main ones are the need for a long, wide runway and the plane's fragile, poorly designed wing, which cuts back the C-5's lifting capability and must be replaced. The best Ny ships to carry the US M.J TODAY Reserves: 209,000 In the Army: 1L ai 1.