A Plan of Prevention
Daily Observer
“What
do you know about Ameriplan, Harry?” The voice of S.Q. Lapius
was confidential. Why did he pick just
that moment to interrupt? When my mind
was unburdened, and I wasn’t concentrating on anything in particular, Lapius was usually silent.
But the moment I became involved, as at this moment, in replaying the
chess game in the Daily Times, Lapius was sure to
derail my train of thought. It was
uncanny.
“The Ameriplan?” I said without looking up from the
board. “You mean a hotel at which
breakfast is included in the price of the room?”
“That’s
the American plan. Ameriplan
is different. Are you interested?”
“For
days, Simon, you have suggested that if I studied the masters’ games in the
papers I might provide better competition for you in chess. I am doing just that. Apparently you don’t want better
competition. I will set it aside and
listen to you.”
“Do
so, Harry. This is more important. If it will assuage your feelings I’ll let you
win a game or two.”
I
deliberately plucked each piece from the board and placed them one by one back
in the box, then sat back to listen.
“Harry,
you are being childish. But never mind
that. The Ameriplan
may affect your future as a physician.
One thing is sure. Everybody is
coming up with a new plan on how medical care in the
“It
sounds fascinating so far,” I offered.
“It
is. It is a comprehensive plan for the
dispensing of what is called health care.
It is oriented to the maintenance of personal good health and the
prevention of illness in contrast to the present system which is primarily oriented
to the treatment of illness after it becomes acute.”
“Sounds
good,” I said, wondering when I would be able to get back to the chess game.
“Well,
if not good, interesting. They propose
to have federal legislation enacted which would require the adoption of federal
regulations defining the scope, standards of quality, and comprehensiveness of
health services and stating the benefits to be provided for all of the
people. These regulations would be
administered at the state level with care being provided locally by the Health
Care Corporation. It gets even better as
it goes along. Listen. ‘Each Health Care Corporation would synthesize
management personnel, and facilities into a corporate structure with the
capacity and responsibilities to deliver the five components of comprehensive
health care to the community, health maintenance, primary care, specialty care,
restorative care, and health related custodial care.’
‘The
proper growth of Health Care Corporations would only occur through the most appropriate
economical use of all resources.
Enforceable regulatory controls would be established by legislation in
each state to assure that needs would be met without unnecessary construction
or duplication of services. –All persons
in the community would have a role in identifying how health services would be
provided – To advance the development of Ameriplan,
legislation must be enacted at the federal level. This legislation which
would set forth the benefits to be provided under the Ameriplan
and adopt regulations. These
regulations would define the scope, standards of quality, and comprehensiveness
of health services, and would be administered by State Health Commissions. In turn, the State Health Commissions would
approve Health Care Corporations and authorize their operation.’”
“Sounds
like someone is packaging oranges,” I said laconically.
“Funny
you should say that, Harry. The group
that devised the plan was headed by a grocer.
The
“But
the credo of the
“Of
course, Harry, but not necessarily at the expense of liberty. Under this plan legislation could be enacted
to abolish cigarettes, alcohol, prostitution, and all the other evils that
provide a little zing to life. Not that
I am for these things, mind you, but I have a feeling that the founding fathers
included in their concept of liberty,
the privilege of foreshorten one’s life by indulging in harmful pleasures.”
“What’s
your point, Simon? After all, there’s
nothing wrong with creating a system that provides for the health of the
people.”
“It’s
the manner by which it is provided, Harry.
After all, Ameriplan is nothing less than a
gigantic bureaucracy. It is health
administered on a corporate basis. It is
the hospital system magnified a million times to include all interpersonal relationships. It will convert medicine into a confrontation
between the patient and a machine; between the patient and an administrative
code book. Look at the average hospital
today. The nurses have been diverted
from patient care to satisfying a series of directives that tell how patient care
should be performed. Instead of nurses
using their common sense to attend a patient’s needs, they must look first to
obeying the rule books and completing the records so that inspection teams will
be satisfied.
But
more important, the system calls for one hundred administrators for every
doctor. Now I have nothing against
administrators. I just don’t like them.”
“That’s
not personal, of course.”
“Not
really,” said Lapius blandly. “But since I can do their job and they can’t
do mine, I feel the positions should be reversed. They should be working for me.”
“That
will be the day, Simon.”
“I
guess you are right, Harry. It seems
more appropriate that doctors should be serving people who had a two year
course in hospital administration, from a remote college in the valleys of the
“You
don’t have to be sarcastic, Simon,”
He
continued unabashed. “I’m exasperated by
the continuing attack on the medical profession, which although it practices to
the highest standards of excellence, is blamed for the inaccessibility of
medical service to large masses of people.”
“Are you saying that the capitalist system
doesn’t work, that free enterprise is dead?”
“No,
Harry, I am just bemoaning the paradox that the free enterprise system spawned
the highest level of medical practice in the world, but that the system will be
socialized in order to provide its services to all Americans.”
“What
alternative do you have?”
“Simple,
Harry. Give all Americans the money to
purchase medical service at predetermined rates, but don’t destroy the uniquely
random marketplace system that has provided the incentive between industry, the
profession and the community, to produce the most sophisticated level of
medical expertise in the world. It would
seem a shame, in order to distribute the high level of health care that is
currently available, to have to kill the system that produced it.”
“In
other words, why kill the goose that laid the golden egg?”
“You
put things so succinctly, Harry.”