Medical Plan Authoritarian

Daily Observer

September 13, 1974

The Medical Society of New Jersey publishes a membership newsletter monthly. The August 1974 issue contains the following statement “The New Jersey Hospital Association has launched a massive assault on the private practice of medicine and intends to continue its offensive until it exercises complete control over the delivery of health care services in New Jersey. In June of 1974 the Board of Trustees of the New Jersey Hospital Association voted to institute suit if the Health Care Administration Board of the State of New Jersey does not promulgate a rule requiring Certificates of Need for the practice of radiology, pathology and rehabilitation medicine.”

This statement is consistent with the aims of the Ameriplan, sponsored by the Special Committee on the Provision of Health Services of the American Hospital Association, headed by wealthy grocer Earl Perloff.

The gist of the plan, which is detailed in a 91 page booklet, is that the nation would be divided into Health Care Corporations that would deliver to the community five components of what the AHA considers comprehensive health care: health maintenance, primary care, specialty care, restorative care, and health-related custodial care.

After a series of assurances that physicians would be encouraged and indeed permitted to participate, and that the corporation would provide peer review to evaluate the quality of health care, the AHA goes on to say that the proper growth of the Health Care Corporations would only occur through the most appropriate economical use of all resources: in addition; “Enforceable regulatory controls would be established by legislation in each state to assure that needs would be met without unnecessary construction or duplication of facilities and services.”

The recent threat by the New Jersey Hospital Association to go to court to assure that the establishment of new medical services be prohibited unless permitted by a Certificate of Need is sufficient evidence that the American Hospital Association’s Ameriplan is authoritarian in nature.

The Certificate of Need is a malignant device used to assure existing hospitals a monopoly in the health field. The rational for its inception is that it will protect the present per-diem hospital rates on the basis of the supposition that if a hospital has empty beds the daily rate for occupied beds will necessarily increase. Since hospitals also make considerable income from outpatient x-ray and laboratory fees, logic demands that the private practice of radiology and laboratory medicine also threaten the fiscal structure of your neighborhood hospital. Indeed, if carried to its absurdly probable conclusion, as emergency room care expands, the existence of the private practitioner of medicine will necessarily be construed as a threat to the hospital.

The fact is that medical care in private offices is more reasonable priced than that in hospitals. Emergency room fees for minor ailments exceed those in the doctor’s office. Laboratory fees on the outside are lower than those charged by hospitals. How then, without the threat of competition, will the American Hospital Association assure that it is working at the lowest possible rate? The answer is simple. There will be no basis of comparison because the hospital corporation will be the only place providing health services.

Much of the hysteria to supplant the current system of medical care arises from the fact that a substantial portion of the population can’t afford it: indeed medical progress is so buttressed with remarkable machinery and techniques, that only a few thousand families could bear the brunt of cost that would accrue for constant kidney dialysis, heart transplant, by-pass surgery and the like. Clearly, however, the fact that the cost of medical care exceeds our means must be blamed not only on the advances in medicine, but on the inequalities of the economic system. None of this, however, will be cured by the Ameriplan or any equivalent health dictatorship. One bounty of private practice is that it provides a competitive market place that forces progress, and provides choice. If a patient doesn’t like his doctor he can choose a different one. But if a Medical Corporation is poorly administered, an entire community will be its captive. There will be no recourse, and no options.

The community already had evidence of this in the number of patients forced to lie in stretchers in the halls of hospitals in Ocean County because the Certificate of Need mechanism is so cumbersome, restrictive and unfair. Health problems won’t be solved by creating a Medical Archipelago in which patients will enter an institution only to disappear somehow in its vast administrative complex, to be spewed forth, perhaps into the community on a given Tuesday. Medical problems won’t be solved by handing the management of “Health” over to a bureaucracy of administrators and making vassals of physicians. Because if this happens, in less than a generation, only a vassal will try to become a physician.

No doubt the government will have to bear the brunt of medical costs. But it should do so in a manner that will continue to stimulate competition and a marketplace: continue to encourage physicians to invest in their own plant and equipment without having to go to a non-medical administrator for permission to institute a better technique. If the free market-place in medical care is abolished the spirit of volunteerism will be extinguished, and the principle of caring for an individual will be supplanted.

Institutes and corporations demonstrate their viability by year-end statements, and reams of paper work that purports to show that all procedures are carried out properly. Institutes demonstrate their efficiency to accreditation committees, by sprucing up their records, getting their ledgers into shape, and compiling pleasing statistics.

Doctors demonstrate their efficacy by converting a sick patient to a healthy patient. There can be no cover up.

It may be true that a doctor can bury his mistakes: but he can’t hide the body. He is accountable in court and in conscience. By what authority does a corporation have the right to practice medicine, and to whom is the corporation accountable?

Check it yourself. Count the stretchers in the hallways, then try to find out who to write to in order to correct this deplorable situation.