Detroit Free Press from Detroit, Michigan • Page 51

SfetroU 4fftee Stress INSIDE: One memorial gets new life while another is abused, then forgotten. Neal Shine, Page 3. Sunday, May 23, 1993 Section Bob Talbert, Page 4 Susan Watson, Page 4 Jane Daugherty, Page 4 Call Comment, 222-2441 Diplomat relishes challenge icial in Detroit wants changing role for Japan BY NORIMITSU ONISHI Free Press Automotive Writer I fi 'ien )etro't'' consul general I I a of Japan speaks about himself, it is almost always with a sharp sense of his place in history. "I am as young as Bill Clinton. rUMMY AC BY R.A.

ZALDIVAR Free Press Washington Staff I was born 'in the same year. My wife is as young as Hillary. Both the U.S. president and I belong to the postwar generation," says Yasukuni Enoki "Perhaps I belong to the new generation in Japan that is more talkative and not hesitant to speak out, and does not have any psychological barriers accepting foreign countries." For years the West has witnessed seemingly faceless prime ministers quickly succeed one another in Japan. No sooner had Americans learned to pronounce a Japanese leader's name than some scandal knocked him out of power.

But even as a Baby Boomer occupies the White House, Japan's postwar generation has begun claiming important political positions. Relatively unscarred by World War II, this generation is free of the awkwardness its elders have felt in dealing with foreigners and it is less likely to bow instinctively to American demands. As he sits in his office on the 68th floor of the Renaissance Center, the 47-year-old Enoki gravely de THE PATIENT Meet Bob Boyd, 64, a veteran Washington reporter, trim and in good health. Boyd hadn't been in a hospital for 13 years before his stomach ache last summer. He gets yearly checkups and has no history of heart problems.

ASHINGTON Maybe it was the tacos. Or the two glasses of wine. Or that slice of moist chocolate cake with the creamy icing. Maybe he should have listened to his achy stomach and never gone to the party in the first place. The exact reason that Bob Boyd The illness: Boyd fainted something that had never happened to him before.

In Houston to cover the 1992 Republican Convention, he went to a Saturday night ate a lot. i 5 I partv, even though he had an upset stomach. He Suddenly, he started feeling woozy, passed out and his head as he fell. UJ 1 passed out last summer in Houston remains a mystery. But the bills the hospital and doctors sent him were perfectly clear.

His three-day brush with the health care system cost $7,955.83, though there was nothing seriously wrong with him. Boyd's $8,000 tummy ache is a parable of a health care system in critical need of a fiscal pacemaker. Americans will pay $940 billion for health care in 1993. Costs are rising faster than 10 percent a year, with no leveling off in sight. How long can it last? A veteran political reporter in the Free Press Washington bureau, Boyd was in Houston to cover the 1992 Republican National Convention in August when he passed out.

Boyd's bill is instructive only because it is so unremarkable. Stories like his are repeated over and over in America these days. Each time, national health costs go higher. A look at his bill helps explain why we spend more for health care than any nation. And why the call for reform is so loud.

For months, a federal task force led by Hillary Rodham Clinton has been struggling with what scribes his government's great expectations for its first representative in Detroit. Although his 25-year diplomatic journey has taken him to France, Egypt, India and Australia, opening a consulate in Detroit may be his toughest I -a -ut Li is I Yasukuni Enoki The emergency room: Boyd came to quickly, and friends took him to Hermann Hospital. He said he was in the emergency room for about six hours before a doctor examined him, took his medical history, and closed his head wound. The charge: $469.50. The doctors' hunch: In their notes, doctors wrote that they suspected a "vasovagal attack," a common cause of fainting in healthy people.

Stress, fear or shock can overstimulate the vagus nerve, which helps control breathing and circulation, resulting in a temporary blackout. The doctors' fear: A previously undetected heart problem that fTl if could cause sudden death. shape that reform should take. The deadline has been pushed back several times, but the latest expectation is that the nation might get a glimpse of their recommendations in mid-June. Some reasons the costs are so high include: We rely on high-tech, high-cost medicine to treat even simple ailments.

The massive expense of caring for 37 million people without health insurance is added to the bills of those who have coverage. Hospitals have evolved a Byzantine pricing system in which markups of 500 percent or more are common. In part, that's because hospitals have to cover the huge cost of treating uninsured patients. In part, there has been no incentive, until recently, to shop around for the best deal. Doctors are pressed to practice defensive medicine out of fear of being sued for malpractice, because they are pressured to use costly new techology, or simply from an excess of cau- The hospital admission: Admitted early Sunday, Boyd spent two nights in a monitoring unit The charge: $1,000 a night One person's brief encounter with the best health care system in the world shows how costs get out of control and why reform is demanded assignment yet.

More than any other city, Detroit stands as the focal point of American anger over the U.S. trade deficit with Japan, which neared $50 billion last year. The U.S. Big Three automakers are still pondering whether to file dumping charges against their Japanese rivals. They are urging the Clinton administration to hike tariffs on imported minivans and sport-utility vehicles to 25 percent.

The United States also has infuriated Japan by encouraging a stronger yen and is expected to draft a hard-line trade policy. Enoki himself opposes quotas and believes that free markets will ultimately correct imbalances. Accepting a larger role Relaxing during lunch at the Renaissance Club, Enoki runs into an American acquaintance from a law firm and chats with American-style informality. A bon vivant, he orders a Bloody Mary and doesn't think twice about topping the meal with a chocolate dessert. Slipping effortlessly from Japanese to English to French, he speaks passionately about Japan, the United States, his own life.

Enoki admires the American worship of individual ambition, and speaks almost enviously of a culture that richly rewards those with great talents. But he also sees good in a paternalistic Japanese society that emphasizes equality and takes care of its weakest members. Like others who grew up after the war, Enoki wants Japan to play a political role commensurate with its economic might in the post-Cold War world. The extent of that political involvement especially in the Far East, which still carries vivid memories of troops from the Japanese Imperial Army is an issue debated more than ever in Japan today. Late last year, for the first time in a half-century, the Japanese government sent troops to foreign soil, although its peacekeeping forces in Cambodia were not armed.

When a Japanese police officer and a civilian volunteer were killed there, many in Japan urged their government to call back the troops. But even though Japan's constitution limits its military role, Enoki says Japan must not shrink from its political responsibilities. "It is not allowed anymore for Japan to remain only passive and to remain a beneficiary of the international order that is maintained by someone else," he says. "We should positively join in this fctemational effort to maintain international security, political and economic" See ENOKI, Page 6F 1 1 1 1 1 I uf2fnrs tux fossae? i discharge1 -v. I I ttoydninS- ii inn in in tl0n- Consumers want the best care but usually have no idea what it might cost, and the insurance system gives them little incentive to look for savings.

The hospital that admitted Boyd for two days of observation and testing charged him $6,601.83. The doctors who examined him for possible heart trouble and found none charged $1,354. After his insurance paid the standard 80 percent, Boyd's share came to nearly $1,600. His reaction: "Oh, my God!" Boyd got the best care in a state-of-the-art hospital staffed by well-trained professionals. "I felt extremely well cared for," said Boyd.

He had never fainted before, and he was relieved to find out that it was nothing serious. But had he known how much it was going to cost him to stay in the hospital, he would not have gone along. Instead, he said, he would have pressed for more information about his chances of being seriously ill, and he would have tried to have the tests done as an outpatient. "There was no incentive on me or on them, no cost-benefit consideration one way or another," said Boyd. The day he was released, one of his doctors advised him on how to avoid future problems: Take Gas-X, an See HEALTH CARE Page 5F No one discussed cost.

There was no incentive on me or on them. 33 Bob Boyd, patient It's good old American enterprise taking advantage of a bad system. 33 Dr. Bryan Latham, outside consultant I was concerned there was something more serious going on. 33 Dr.

Laura Colletti, handled Boyd's case Columnist Mitch Albosn has the day off. -j.