Putting caps on medical malpractice suit awards, placing more limits on medical and hospital fees and requiring those who abuse

their bodies to pay the cost of their own care - those are among James C. Fletcher's suggestions to get a handle on escalating health care costs.Fletcher, former director of the National Aeronautics and Space Administration, gave the keynote address Thursday at the Utah Hospital's Association's 12th annual convention. He said health care costs have increased dramatically in the United States during the past 25 years, "and only half of that is due to inflation."

In an interview he said, "Health-care costs can't continue going up. The nation will go bankrupt."

Fletcher, who was the first man to head NASA on two separate occasions and who earlier was president of the University of Utah, discussed "Space Exploration and Medical Technology - Twin Pioneers in the Next Century." The theme for the convention, which continues through Friday afternoon, is "The Quest for Healthcare Solutions - A Decade of Decisions."

In a video presentation, much of which highlighted medical and other spinoffs from space exploration and research, the incidence of illness and related health statistics, Fletcher said rapidly developing technology has its good and bad points.

It has cured and helped many people and prevented deaths, he said. But for a lot of other people it has contributed to escalating costs. They include larger malpractice insurance premiums for doctors and other health-care personnel and higher costs for patient care.

The scientist, who was on the team that developed the first artificial heart, said much progress has been made in the medical and hospital field. But he said many problems need solutions.

"It's clear that we need to focus more on prevention of disease and not cure. How to do this is not clear because doctors and even hospitals are not motivated to do that," Fletcher said.

He said C. Everett Koop, the former U.S. surgeon general, had a clear idea on ways Americans can improve their health and that Koop's successor will likely follow suit.

Fletcher said the nation must make a greater effort to place caps on medical and hospital fees and put a limit on the amount that can be awarded in a malpractice suit. Some of the amounts have been enormous, he said.

"It's impossible to put a dollar value on a human life, but . . . we (can't let) lawyers' malpractice suits get out of hand," Fletcher said.

He said he believes the Medicare-Medicaid program, which is costing $50 billion a year, has lost its focus and no longer does what it was originally intended to do. He said the cost of all health care runs $600 billion a year or 12 percent of the GNP (gross national product).

Regarding care of the elderly, Fletcher urged a "redirection of our energies . . . - not by pouring (money) into the problem but by creating, to the extent possible, technologies that make it easy for older people to be independent."

Fletcher said many people hang onto bad health habits - specifically mentioning alcohol and tobacco - then "rely on doctors to cure them when they are sick."

He said, "I don't think that is fair. I don't smoke and I don't drink . . . unfortunately, I'm trying to cut back my cholesterol (but) I'm making progress. Nevertheless, I kind of resent having to pay all of this money - $1 out of $8 that I earn - into taking care of those people who do have those (smoking and drinking) habits."

"Ultimately," he said, "we're going to have to deal with that problem," because people will revolt against having to pay for the care of people who refuse to take care of their own bodies. Most people don't mind paying for true medical emergencies, but they don't want to pay for those who risk their health against medical and other advice, Fletcher said.

He said driving while drinking or reckless driving must be included in the list of poor health practices. He said insurance companies are charging higher premiums for such continued behavior.

He said it's difficult to control people's lifestyles, although airlines in the United States are doing a "reasonably good job" with their rules on smoking.

In his talk and in an interview Fletcher placed strong emphasis on medical and other spinoffs spawned from space exploration and research.