Taking care of the nation's health has become a 1 trillion dollar industry. We have the highest health care costs in the world, and at the same time, probably the best delivery system of any country. But, we cannot and must not ignore some 44 million uninsured Americans. This is the issue that the next Congress will have to consider. Along with coverage issues, the Congress will also have to focus on who pays for the growing health care bill.

I see several basic problems remaining in the health care debate. The most obvious issue is the lack of coverage. Some 44 million of us are not covered. In a nation as wealthy as the United States, this is not acceptable. To start with, more employers have to provide health insurance coverage. I cannot accept the argument that some employers cannot afford the coverage. To help meet that objective, premiums should be fully tax deductible for all premiums paid by employers. Any portion paid by employees should also be fully deductible. If you can deduct the mortgage payment for the roof over your head, why not be able to deduct health insurance premiums?

In the administrative area of health insurance, the paper work must be simplified through the use of standardized insurance forms. In addition, more computerized systems should be available in the hospital and the doctor's office. An American Express or Visa card can buy anything for you all over the world. But, your health insurance card is mostly useless even though that black strip on the back is capable of carrying encoded information. It is up to the insurance industry to get together and move toward the next century. Starting with the insurance card would certainly help cut the flow of paper.

As for managed care, I would take a wait and see attitude. New York, a generally liberal state, was one of the last areas of the country to see the introduction of managed care systems. Remember, managed care came into being to address constantly escalating costs of insurance¬driven by out of control medical prices. Doctors and hospitals did not mind raising prices, and the patients were shielded because of insurance coverage. And both hospitals and doctors have had their own cost pressures. The result was higher insurance premiums with employers taking the brunt of the increased costs. Managed care is not meant to prevent doctors from performing services. It is meant to make sure the services are effective and needed. The public cannot have it both ways. If costs are to be contained, managed care has to be a reality.

There is no doubt that part of the health delivery system is flawed. But, also keep in mind that over 200 million of us have pretty decent coverage. The Congress must be careful not to throw out the good while implementing changes. Stay tuned as the health care debate promises to come to the forefront in the next Congress.