My perspective is local.

Shaping that perspective are 36 years as a physician, with a little over 30 years in Cape Girardeau. Over that time I have been fortunate to care for many patients. I have watched and participated in our community's evolution into a regional referral center. Technologies and treatments that were undreamed of when I began practicing medicine are now routine.

It has been a wonderful experience.

Naturally, I am disturbed when I hear so much criticism from people who have an agenda-driven bias as their primary qualification. These "talking heads" make our health care system sound like a mess, but that is far from my experience, either as a provider or consumer.

A recent discussion by Dr. Ronald Wenger in the Bulletin of the American College of Surgeons reviews the strengths and weaknesses of our current system, taking pains to point out both. As the debate always seems to center on the deficiencies of current practice, I thought it interesting to consider some objective attributes that transcend my local perspective.

The best health care institutions in the world are in the U.S. These include the Mayo Clinic, M.D. Anderson Cancer Center and Massachusetts General Hospital. Students and physicians from all over the world come preferentially to the U.S. for medical school and advanced training. Patients from all over the world come to the U.S. for health care. They don't come because schooling, training and treatment are the cheapest. They come because they're the best.

By many measurements, the U.S. health care system is unrivaled. Cardiac deaths have fallen by two-thirds in the past 50 years, and not only in urban centers. Just today I saw a man who had heart surgery in Cape Girardeau 25 years ago, probably one of the first. Because of that procedure, a rarity in a community hospital at the time, he's still alive today to complain about his prostate and enjoy his great-grandchildren.

The Nobel Prizes in medicine and physiology have been awarded to more Americans than to researchers in all other countries combined. Eight of the top 10 medical advances of the past 20 years were developed in or had roots in the U.S. Eight of the 10 top-selling drugs in the world are made by U.S. companies. The U.S. has some of the highest breast, colon and prostate cancer survival rates in the world. The U.S. is responsible for more than 53 percent of drug research dollars spent in the world. The U.S. ranks first or second in the world in kidney transplants, liver transplants, heart transplants, total knee replacements, bone-marrow transplants and coronary-artery bypass per capita. The U.S. has the shortest waiting time for non-emergent surgery in the industrialized world.

The U.S. spends more per capita for health care than any other country. Perhaps this is simply a reflection of the high value American citizens place on their health care. What do we get for that? We get what American citizens have come to expect:

* Easy access to sophisticated diagnostic tests, including MRIs and CT scans.

* Shortest waiting time for elective surgery in the world.

* Easy accessibility to joint replacement.

* Widest choice of physicians and hospitals.

* High access to renal dialysis.

* Easy access to cancer screening and treatment.

* Greater access to health care for older Americans due to lack of rationing.

The system that promises unlimited care with no premiums, no deductibles, no co-pays, no waiting lists, no rationing and treatment from the physician of one's choice does not exist anywhere in the world. Current proposals for remaking our system will, as in other countries, lead to rationing, waiting lines, insufficient hospital beds and restricted access to critical diagnostic tools such as MRI and CT scanners. Perhaps most importantly, these proposals will delay the development and dissemination of the new. This will particularly impact developing centers of treatment such as Cape Girardeau, rendering us less competitive with our larger rivals.

A recent example is the early adoption of robotic surgery in Cape Girardeau -- before many major medical centers. Already hundreds of patients in this area have had these marvelous procedures for cancer, heart disease and other conditions experiencing superior cures with fewer side effects and minimal pain. Under current proposals these opportunities for innovation will disappear. Say goodbye Cape Girardeau, hello St. Louis -- goodbye choice, hello mandate.

Make no mistake. The current administration's proposals will result in the flight of capital from our area to urban centers. It will adversely affect health care jobs, retail, lodging, restaurants, banking, municipal tax base and all those directly or indirectly related to those sectors.

Those with a vested interest in a guilty verdict of the U.S. health care system have carefully chosen arguments and facts that support only their point of view. These harsh judgments conflict both with the attributes listed above and with my years of experience here.

Although we have yet to achieve perfection in the delivery of heath care in this country, the system is far from broken. The current discussion, despite the rhetoric to the contrary, is about how little we are willing to accept. It must be turned from how to wreck and replace to correcting its weaknesses. If we are not active in saving our leaders from themselves, we have no one but ourselves to blame.

As I said, my perspective is local. As such, I dearly miss the keen intellects and incisive insights of two recently departed physicians. I refer to Dr. Jean Chapman and Dr. Ed Masters. Their grasp and understanding of the topics addressed above were only exceeded by commitment to their patients. We are all poorer deprived of their counsel.

J. Russell Felker is a Cape Girardeau urologist.