Evening star., 1945-12-09
Doctors Seek Substitute
For US. Health Program
American Medical Association Studies Plan for
Nongovernmental Insurance to Safe.
guard Discretion of Individual
By Thomas r. Henry

cannot be dealt with on any sweeping
basis. Each case presents its own pecul-
lar problem and medicine becomes both
science and an art
There can be no question but that the
cost of medical care is high. This is
inherent in the practice of a combined
exact science and fine art. The burden
falls heaviest on persons of moderate
incomes. 1t is an old truism that the
best in medicine is shared by the very
poor and the very rich. For the former,
communities have provided free hos
pftals and the medical profession, in
accordance with its ancient tradition of
service, gives its best efforts for moth
ing. The rich, of course, can afford to
pay. 1t has been to some extent the
practice of doctors to soak the rich to
carry on their work for the poor This
has not been very satisfactory, either to
the wealthy patients or the physicians.
But the family whose income just about
meets ordinary living expenses often
gets terrific economic blow from un-
predictable illness.
Sometimes the members struggle for
years to meet the bills and seriously re-
duce their standards of living. Some
times they simply do not pay. 1t is
generally supposed, by doctors, that their
bills are the last to be met. That is one
OF the reasons for the high cost of med
icine. Those who do pay must make up
for those who do not and the physician
who was able to collect all his bills could
cut down his charges by big margin.
Sickness Unpredictable.
Now the family with a moderate in
come can insure against other unpre-
dictable expenses, such as fire, death of
a breadwinner, etc. Why can they not
insure against catastrophe sickness?
One reason is that the former type of
catastrophies can be predicted by exact
actuarial statistics. 1t is pretty safe bet
that certain number of dwelling houses
in Washington will catch fire in the next
six months. There is little element of
guess work in predicting how many
Washingtonians in the 60-year -age
group Will Qle IN 1880.
Medical practice is different One
cannot predict Sickness because there is
such large subjective element about it.
Every person differs from every other
person. Some demand medical services
for complaints which would be regarded
as inconsequential by others. Doctors
sometimes make the cynical comment
that the best way to cut down the sick
ness rate of community is to raise
prices for medical services.
Insurance against sickness costs In
general, doctors say, would be unpre-
dictably and prohibitively expensive.
Various schemes Of political medicine
have been tried. Perhaps the best
known Is the British panel system,
which is not far removed in principle
from that proposed in the Wagner
Murray-Dingel bill, although the latter
would give larger leeway for personal
choice. A group of British physicians
constitutes panel. Each panel has a
certain number of patients, who make
their own free choice of the doctors on
the panel. Only within this group does
the patient select his own physician.
Each constituent of panel pays a
stated fee each year.
Dodge Responsibility.
There are various claims as to how
well this has worked. The conclusion
of most American observers is that it is
quite inefficient. The panel physicians
are inclined to treat only the simplest of
ailments. They are not held responsible
for specialist service and this gives them
an opportunity to avoid responsibility.
From his own observations, Dr.. Lee
says, the higher type of independent
British physician is as good as any in
the world, but the panel doctors fall
far below the average American practi-
TONERS. They are much more inclined
to sell medical care over the counter.
like potatoes or cheese. They reach the
point where the peculiarities of the in
dividual mean nothing.
One of the greatest political med
icine" experiments was that of the Vet
Grams Administration after the last war.
when corps of physicians was set up
to care for veterans with war connected
disabilities. Over a course of years it
proved dismal failure and veterans
hospitals were byword everywhere for
ineficiency.
The present administration, under
Maj. Gen. Paul R. Hawley, proposes to
do away with this system to very large
extent and rely on the American private
physician, freely chosen by the patient
himself, to treat the 10000 900 veterans
of the Second World War.
Healthiest in World.
These 100000, by the way, 20 a
long way toward nullifying the value of
any compulsory health scheme
tuting. as they do, such a considerable
element of the American population.
They have already the best sort of sick
ness insurance, for nothing. True, 1t is
supposed to extend only to war-connect-
ed disabilities, but in actual practice the
dividing line is hard to draw.
A good deal has been made of the
poor health of the American people un-
der the present system-as revealed by
the numbers rejected by the draft for
physical and mental defects. This is
all bunk, say the doctors. The American
people are the healthiest in the world
No sort Of medical service ever could
have remedied good many of the de-
fects for which men were rejected BY
the Army. Doctors cannot repair con-
stitutional weaknesses. They cannot
raise subnormal intelligence. A good
many Of these rejected by the draft
boards would have had the same de.