Radical Surgery.

• Author: Wofford, Harris

Joseph Califano Times Books, $25 By Harris Wofford

The failure of the 103rd Congress to take even the first steps in health care reform left a void in a vital national debate. With a punchy, provocative, and enlightening new book entitled Radical Surgery, Joseph Califano, former secretary of Health, Education, and Welfare, helps fill that void. In 316 pages of short bursts of simple but often contradictory truths about what he calls our "sick care" system, Califano outlines the problems that plague American health care and points towards a solution.

Halfway through, the book seems maddeningly repetitive. Califano makes the same basic points again and again. Open the book to any page, and Califano's fundamental prescriptions leap out at you. But there's a method in this madness. After enough doses of this medicine, delivered in vivid language, with striking new statistics or personal anecdotes, Califano's prescriptions begin to do their work.

We see Califano's 92-year-old demented mother, with kidney failure, who had been promised by her son not to be sent to die in a hospital, but whose doctor intended to hospitalize her for dialysis and other "heroic" measures to prolong her life. Her son said, "She's ready for God," and took responsibility for letting her die at peace in her own bed, with her husband holding her hand.

Two hundred and twenty-eight pages later, there are the stories of Richard Nixon and Jacqueline Kennedy Onassis, each having signed a living will, declining the use of medical machinery to postpone imminent death. Califano hopes that the grace and dignity with which Jackie died will have even more lasting influence on American social customs than the courage she displayed when John Kennedy was assassinated. Califano tells of the brave old Polish Cardinal Wyszynski who said from his sickbed, "There are too many machines and tubes and wires," and asked if United States doctors were sensitive to "the need for one person to touch another."

Califano rails at the bureaucratization of modern medicine, which leaves little time for touching. "What we need from our doctors is less of this new T.L.C.--technology, lasers, and cat scans--and more of the old T.L.C.--tender loving care--grounded in a basic respect for human dignity." He sees that the central truth that the practice of medicine is "a sacred calling, not a for-profit enterprise," is "being choked in the thick underbrush of regulatory and insurance reimbursement rules and...