Meaningful health care reform is not rocket science. Not, at least, if we give primacy to the public interest — universal access at an acceptable level of taxpayer expense. It gets complicated only when we insist on maintaining the status quo for those who have been taking unfair advantage for years.

It can be accomplished through legislation, but only if legislators can have the courage to ignore pressures from those whose gravy train may be derailed in the process, and to suppress partisan reflexes and personal ambitions. And they should not act until they can get it right, with shame on them (our legislators) and the Clinton administration that the process is taking so long.

It all came into focus for me recently in the office of a local “health care provider.” As I prepared to pay for services rendered, the “provider” asked, “How are you going to pay?” I replied I would be paying cash, hoping for an eventual (partial) reimbursement from an insurance company. Response, “That’s great! I can give you a big discount!” With a candor of which her supervisors might not have approved, my “provider” explained I would pay $51 for services for which other “payers” (private insurance, Medicare or Medicaid) would have been charged $102!

We don’t have to choose between “universal access” and excessive public expenditure for health care. Neither must we dictate to employers whether to include health care insurance in the benefits package they offer as incentives to their employees. We do have to make major adjustments in the pricing of health care services and to slow down the consumption thereof. Down there “inside the Beltway,” they’ve been talking mostly about the wrong thing, groping to find ways to pay for a product that is badly over-priced to begin with, rather than to find ways to reduce the cost of the over-priced product.

Meaningful health care reform can be achieved at half the current burden on U.S. taxpayers by including the following concepts in the program:

Price controls. In a state of war on a health care rogue totally out of control and a real threat to the “national security,” price controls are totally appropriate. The Europeans and the Canadians have been doing it for years. Controls should extend to all providers and to the prices of manufactured goods, including pharmaceuticals. It should apply also to insurance premiums, legal fees and other health care related services. In the anecdote cited above, a reasonable price for the service rendered would probably have been about $40, compared with the $102. Medicare or private insurance would have been charged. By calculation critics might find oversimplified, we can project that price controls alone could reduce public expenditure on health care by as much as 50 percent.

Consumer responsibility. Over-consumption of health care is an important part of the problem. Responsibility lies with the industry which stimulates that over-consumption through everything from excessive pharmaceutical advertising to unnecessary medical procedures, to lawyers’ promtion of liability litigation. But responsibility lies also with the consumer who fails to take adequate charge of his-her own care. Meaningful health care reform will create incentives for consumer participation in preventive and primary care programs.

Tax credits would be one approach. Over-consumption could also be reduced if the consumer were more engaged in the payment process. If consumers paid “cash,” for prompt reimbursement in part or in full, some volume of unnecessary procedures and services might be avoided. And consumption could be slowed further if consumers were required to pay “out of pocket” for at least a token portion of the biling.

Limitation of liability for health care providers. We need to relieve our physicians and other “providers” from this spectre, which also serves them as a rationale for maintaining higher fee schedules. Surely it will be possible to draft legislation in such a way as to provide adequate safeguards for patients while removing this basis for an insurance and legal services “feeding frenzy.”

Publicly subsidized education for health care providers. Free education for physicians and other health care providers would take away another “provider” argument for sustaining excessive fee schedules. Its impact on the taxpayer would surely be only a fraction of the savings on reduced physicians’ fees. And, of course, the medical training tuition and fees would be subject to price controls. And free education for health care providers just might improve the quality of applicants for such training.

Multiple payer. A role probably remains for private heath insurance, if participating companies can become more responsive and can accept premium rate controls and other dictates of insurance reform totally appropriate for health care, a segment of our national activity the quality of which must be measured only in terms of the common good not commercial profit. Indeed, the concept of private nonprofit insurance organizations, with conservative executive salary caps, is one which should be more closely examined. Federal government insurance must remain, of course, as guarantor for those whose income-assets are insufficient to cover the costs of health care and-or private health care insurance.

Robert Sargent is a former United States diplomat and a trustee of the Blue Hill Memorial Hospital.