The Health-Industrial
Complex
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 Permanente 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!”