Stopping
Medical Treatment Can Eliminate Costs
Secretary Joseph A. Califano,
Jr., in his speech prepared for delivery to the American Medical Association’s
House of Delegates, says that the Carter administration views doctors as
leaders in an overly expensive “big business” of medical care that is
insensitive to cost and insufficiently concerned with disease prevention. He wonders why doctors have the power to
choose specialists, rather than the patients who might opt for cheaper
specialists. Califano
said the health care system emphasized acute care, and there was no economic
incentive to stress disease prevention.
Of course, the Secretary has his ideas
screwed on backwards. In the first
place, doctors are very concerned with disease prevention. When a heart attack occurs, doctors
concentrate their efforts on prevention complications of the crisis. This saves lives. Saving lives costs money, and spending money
on medical care causes Califano to say things as
Secretary of HEW that he could never say if he were a patient.
Medical care is the province of the
doctor, but the health care Califano wants prevention
for is the province of the Carter administration.
Preventive health care means abolishing
the cigarette industry, the liquor industry, and placing sharp curbs on the
automobile industry. It means limiting
traffic, reducing the number of autos racing on the speedways, substituting
mass transit, and eliminating smog. It
means ridding ourselves of poverty and malnutrition. The government is trying to sell its version
of health care to the public like a secondhand automobile; the cheaper the
better.
In order to
try to clarify matters, I called my friend, Perfidy, who works at HEW.
“You read the
Secretary’s remarks?” I prompted.
“Of course,”
he said. “Great speech, wasn’t it?”
“But Perfidy, certainly the Secretary
knows that we can’t ignore acute diseases.
Doctors can’t walk away from heart attacks.”
“But you must
try to prevent them, that is the great vision of our Secretary.”
“But how about
strokes?” I asked. “How does one prevent
them?”
“That is where you doctors fall
short. That’s your job, not his. Our Secretary is merely pointing the way.”
“But Perfidy, the medical profession
has been effective in disease prevention.
The reason people have strokes and heart attacks is that they live into
the age where diseases occur. Fifty
years ago, they died of pneumonia and meningitis, and things like that. But these diseases have been prevented to
allow other diseases to take their place.”
“Quite right,
old boy. You must now prevent these.”
“But this can’t be accomplished
overnight, Perfidy. It will take years
of research. What I mean to say is that,
as long as there is life, there will be disease, and that is what the doctor is
here to deal with and try to cure. The
older people get, the more complex the diseases we have to deal with, and the
more expensive they are to cure. What
does the Secretary think about that?”
“He has an ace in the hold, old
boy. He quite agrees that as long as
there is life there is disease.”
“So we agree,
then. Why does he go around making
stupid remarks?”
“Because we
can’t afford curing disease at the rate you fellows are curing it.”
“Then he
thinks we are doing a good job?”
“Too darned
expensive, though.”
“Well, frankly, Perfidy, I don’t know
how to cut the expense. When I get a
patient, I don’t worry about the expense.
I just try to get the patient better.”
“That’s what
the Secretary said. You fellows don’t
care about the cost.”
“But Perfidy,
when there is life, there is hope.”
“Precisely. And when there is no life, there is no hope.”
“Perfidy, the
Secretary is not suggesting …?”
“Not what you thank old boy. Not at all.
He is not even hinting at euthanasia.
But there is no doubt in his mind that, if we could do more abortions,
the health costs would drop. As you
said, when there is no life, there is no disease. Abortion is the best preventive medicine of
all.”
“You know, Perfidy,” I said, dismayed
and shocked, “you fellows have gone bananas.
Why don’t you just eliminate doctors altogether. Then your costs would drop to zero.”
“Well, it’s not official, but if you
fellows don’t cooperate on costs, it may just come to that,” Perfidy answered.