The Doctors v. Socialism

When the National Health Assembly (called by the Federal Security Administration) met in Washington last week, everybody expected a scrap. The American Medical Association, champion of medicine-as-it-is, was in one corner. In the other: spokesmen for farm groups, labor unions, consumers' associations and minority medical groups, all of which believe that U.S. medical care is too expensive and fails to reach the people who need it most.

To the surprise of some, who underestimated the ability of the A.M.A. to retreat gracefully, there was a sizable area of agreement. All factions, including the A.M.A., endorsed the principle of "contributory health insurance." The big issue: What kind should it be?

The A.M.A. insists that all medical prepayment plans should be controlled by medical men (i.e., medical associations), to preserve the traditional patient-doctor relationship (including, say critics, the right of well-established physicians to charge as much as their consciences allow).

The A.F.L., the C.I.O., the Physicians' Forum and other spokesmen for low-income groups protested loudly that this "free" system (in preponderant effect at present) results in overcharging and under-service. Farm spokesmen pointed out that many rural areas have few doctors or none. Only the richest parts of the country have enough medical services. The poorer parts, whose health affects the health and strength of the nation, are shunned by doctors as feeless medical wastelands. The only solution to the problem, cried labor, is national health insurance, financed and administered, when necessary, by the Government.

In the middle ground, between medical "free enterprise" and national health insurance, are the "voluntary insurance plans," such as the Blue Cross (hospitalization) and the Blue Shield (doctors' fees). At the Assembly they were represented by Dr. Paul R. Hawley, former medical director of the Veterans Administration. The Blue Cross and Shield, said Hawley, if properly developed and extended, can enable people to prepay their medical costs while avoiding the disadvantages of "socialized" medicine. As proof, he cited the rapid recent growth of the two plans. Together they have 37,500,000 members; Blue Shield has increased its membership 3,500% in eight years.

The Assembly came to no definite conclusion. But Dr. Hawley announced: "This has been an extremely important meeting, at which the demands of large consumer groups were set forward forcibly. They cannot be ignored by medicine or the voluntary prepayment agencies. Their demands have to be met . . ."

In Britain, where socialized medicine is about to become a fact (but not without some last-ditch fighting), the British Medical Association reluctantly came to a decision. After a vote of its members, it decided not to oppose (and force its members to boycott) the government's National Health Service. When the Health Act goes into effect on July 5, every Briton will be entitled to free medical service at government expense. British doctors who join the Service will get a yearly retainer of -L-300 ($1,200) plus additional fees for services rendered.

To get a favorable vote (British doctors voted overwhelmingly against the Service in February), Health Minister "Nye" Bevan made reassuring noises. The -L-300 retainer, he promised, is not an entering wedge toward a straight government salary. Doctors who join the Service can leave it after a trial, he said, and can always engage in private practice on the side.

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