There Is a Difference

Daily Observer

January 25, 1974

I had never seen Lapius so eager to get to a lecture hall, with no promise of late buffet to lure him. The talk, to be held at the Academy, was sponsored by the League for Political Involvement, an organization I had never heard of.

“Hurry, Harry,” Lapius croaked hoarsely, “we’ll be late.” He had laryngitis, and for two days there had been a welcome silence as he scribbled notes to me, mainly instructions about food, alcoholic medicinals, and poultices for his neck. Tonight he was draped in a woolen muffler which scarcely suppressed the smell of wintergreen that bathed his neck. We bundled into a taxi and soon were wedged into the narrow theater seats at the Academy. We arrived about five minutes late and the talk was in full progress. I dozed from time to time but Lapius kept poking me, and finally scribbled a note, “Stay awake, damn it. This is important.” I missed a lot of it because the speaker was monotonous, but, in synopsis, it went something like this.

“There is a difference between medical care and health care. The former is a system in which a person goes to a doctor because he is ill. The latter system offers comprehensive health care. In the first system the patient seeks care, in the second, care is supposed to be delivered to the patient. Obviously, either system is expensive, and currently there are several plans extant to cover the costs. You all know Blue Cross, Blue Shield. Then there is private insurance underwritten by large carrier, Medicare and title 19, or Medicaid, for the elderly and the poor respectively. –In addition there is the Kaiser Permanent plan which is a non-profit medical corporation that renders service to large blocks of people, such as unions, provides free hospitalization, and is so geared that the incentive for the profit sharing doctor group is to shorten hospital stays so that there will be larger profit to share at the end of the year. In the wings are the Medical Corporation plans of the American Hospital Association, and the Medicredit plan of the American Medical Association. There are also government-funded clinics subsidized through Housing and Urban Development and other governmental agencies are operating in the so-called inner city areas for the very poor. So although private practice and the traditional person to person relationship of a patient to his doctor still exists the trend is definitely towards medical groups and corporate practice. Because of the difficulty that an individual doctor has in negotiating fees with large carriers or governmental agencies, and because many feel that some of these agencies use their financial clout to influence terms of in-hospital medical practice, doctors are forming unions.

Medical practice is in reality becoming a service delivered by power blocks rather than by individuals. I doubt that the government will nationalize medical services until it has a chance to see various plans in action, and test their durability. The nation is too diverse to institute just one or the other plan. For instance, in rural areas, there isn’t sufficient population density to warrant the Kaiser plan, or even perhaps, the medical corporations envisioned by the Hospital Association. –The nation is struggling with the problem of bringing the highest level of medical care to its people. Technology and communication are available for this. In the process the practicing physician, as we know him today, will disappear. His place will be taken by a different sort, one not so averse to fitting into administrative systems, for the doctor of today will not readily suffer himself to be cramped into restrictive molds. But there are many who don’t mind this, and they will become the doctors of tomorrow. –It is difficult to say how this will affect the research thrust of American medicine, but this will also be a function on the level of government research subsidy.

“To integrate medical services, large medical centers, for specialized function will emerge and duplication of services will be avoided. Hospital construction will accelerate. The electronics industry will cooperate to provide home monitoring systems, some of which are already in use, so that someone with a pacemaker can dial a number, plug in a jack and be told whether or not to come in for a new battery. The miniature telemetry that has spilled over from the space effort has already made its influence felt, and clever analytical devices and monitoring modules will be on the market. Sophisticated tests that a few years ago could only be performed in large centers will be available for offices, clinics, what have you. The plastics industry enables doctors to look around corners into every crevice of the body with relative ease.

“-It is canard to say that doctors are unpopular. They are possibly the most popular element in our society, or else why cry all the time for more doctors. Actually, everybody likes the doctor. It’s just their take-home pay that people don’t like, and strong forces are joining hands to restrict it.

“In short, we are in the process of forming a health-industrial complex that will dwarf the military-industrial complex that President Eisenhower warned against. Numerous citizens opposed the military-industrial combination because it is easy to be against war. But it will be very difficult on any grounds to oppose the health-industrial complex because what citizen, legislature or congressman will dare cast a vote against health? The doctors, of course, will lose considerable freedom in such a system. But they might not be the only ones.

“A collective health system is, by necessity, an administrative system, and administrative systems are harsh, and restrictive of everybody’s freedom. If improperly organized, we could find ourselves one day living under a health czar, or an administrative health establishment where people can be told you must do thus and such because it is good for your health, and the health of your community. A comprehensive health system will have power to regulate ecology energy sources, sewage disposal, and construction. It will have to eliminate slums, rats and infestations to provide for a healthy atmosphere. It will be empowered to order mass vaccination programs---all this power deriving from a central source.

I don’t argue against the concept of a government dedicating itself to the health of its citizens. That’s what governments are for. But in the process of trying to attain this higher level of social organization, beware that those who govern your health have at least the professional credentials to presume to do such a job, and that power is balanced by opposing forces--.”

After it was over, Lapius was beaming. “Did you like it, Harry?”

“Not really.”

Just then the moderator regained the lectern and spoke into the microphone. “I want to thank Mr. Tunney for presenting the lecture on behalf of Dr. Simon Q. Lapius, whose laryngitis---.”

“Ooops!”