Plop Plop, Fizz Fizz

...Do I want to deny the elderly and the poor the medical care they need...

...Little do they know...

...Already the first instruments of medical rationing are in place and beginning to operate...

...What is tragic is that there is a mechanism for combining humanitarianism with a healthy respect for medical economy...

...We were poor when I was a kid but that didn't mean we didn't get medical care...

...Anybody remember when Jimmy Carter ran against Washington and all those dreadful regulators and regulations that made life impossible for ordinary folks like us...

...Ten yesrs of sucoessful u~e of thi~ re;reedy i . hospital a n d p r l v a t e practice by plD'slclans h~s demonsta'ated the fact t h a t it removes the acldfrom rue system, cheeks the formation, and dJ~olves r~cent del~mlts...

...The Karen Quinlans of the world would not be allowed to remain under care, unconscious, living their vegetable existences without hope, forever...

...Brought up in an atmosphere in which individualism was encouraged, it is small wonder that Reeve, the youngest daughter, cannot possibly understand how biographers such as Kenneth Davis see her father as a "totalitarian" personality...

...Powell's Law stands there glowering all the time...

...Following the example of his own father and grandfather back in Minnesota, Charles Lindbergh let his children find their own way...

...Of course, if you were dying of incurable cancer, you might think the something to be done would be a doubling or tripling of spending on research about your particular type of malignancy...

...The hospital that isn't built can't be used for patients...

...The Alternative: An American Spectator May 1977 9...

...The doctors needn't be so cocky...

...And why not try them all if it's " f r e e " ? Dr...

...When, as a girl in the benighted sixties, she voiced doubts about American democracy, Lindbergh--the alleged anti-democrat--argued "long and intensely" that her "starry-eyed" Leffish friends failed to appreciate the advantages of a "correctible democracy...

...Most conditions you take them for go away of their own accord...

...But, as the British discovered long ago, the best means to ration medical care--by making you wait for it, wait perhaps until you die - - i s by making resources unavailable...

...Without cost restraints, Federal spending for Medicare and Medicaid alone would climb 75 % between 1978 and 1982, from $38 billion to $66 billion...

...In each case the point is the same: The committee would have the job of deciding when enough is enough...

...When that fee schedule goes in, the doctor will give you your 30 seconds, no more and no less...

...The solution would seem to be obvious: Find out what inflationary monster was let loose in 1966, get rid of it, and health spending per person would zoom down again--maybe not all the way to $212, but $300 ought to be The Alternative: An American Spectator May 1977 7 attainable...

...To my mind, first-dollar medical or hospital insurance of any kind ought to be outlawed--with a very stiff penalty for violation...

...The surgeon who isn't trained can't operate...

...And so it will go as the policemen dig in...

...Just take care of them, and all will be well...

...Now kidney dialysis keeps patients alive and functioning for years and kidney transplants--in thousands of cases already--have made patients almost as good as new...

...But here in the United States we've been on a jag building hospitals, training doctors, buying equipment, etc...

...WHITEHALL MEOR|MINE CO., 318 N. Main Street, South I~nd, ind...

...There is always another doctor who can be called in, another treatment that can be tried, another amenity that can be installed to ease the lot of the afflicted one...

...When we talk about illnesses these days, we usually discuss either esoteric and exotic ailments like Legionnaires Disease or virtually nonexistent diseases like swine flu...

...Of course the drug companies are complaining and fighting, and even as I write, hearings on these momentous issues are going on in Washington...

...Health care costs too much and something's got to be done about it...

...A heart attack that would have been fatal a decade ago you may now recover from and go back to work--but only after spending a month in the coronary intensive care unit where the cost may exceed $500 a day...

...My maternal grandmother --may God rest her soul--got such good medical care in this country on practically zero income that she died at age 92 well before Medicare...

...Cost containment" is the magic phrase to mention early and often if you find yourself at a cocktail party or a massage parlor with a group of health apparatchiks...

...This should be done regardless of age--90-yearold Cyrus Eaton doesn't need Medicare--and the use of a percentage of income as the cut-off point means that expenditures which would be considered normal for a family from Great Neck or Newport Beach would be considered catastrophic for a family living in Bedford-Stuyvesant or Watts or Appalachia...

...That was the year Medicaid and Medicare got off the ground, going from zero dollars spending to next fiscal year's budgeted $38 billion...

...The ideas have been around for years...

...Maybe they do...

...The point is that as health care becomes more and more " f r e e , " whether because of Medicare and Medicaid, or because of national health insurance, or because you've been enrolled in a Health Maintenance Organization, it has to be rationed somehow...

...Many voters, unfortunately, and even more the demagogues who crowd the electoral lists each year, prefer to think that even one dollar paid by the patient for medical care is a disaster...

...Here in standard bureaucratic prose is the Carter Adrninistration's description of the health care cost crisis as given in President Jimmy's budget revision statement last February: "National health spending per person has more than tripled during the last decade, from $212 in 1966 to $638 in 1976...

...Such language isn't used on drug labels whose authors are all born-again Puritans...

...You won't like it when they close that hospital down and you have to go m another one 20 blocks or 20 miles away, depending on where you live...

...Even as I write these words, a titanic struggle is underway in Washington, D.C...

...Each over-the-counter remedy will have a few prim, standardly phrased claims authenticated on the label and that's all the advertisers are going to be able to talk about...

...And imagine how doctors' fees and hospital room rates would crumble in consequence...

...There's so much free floating guilt around--after all, wouldn't you feel guilty if you were J o e Califano and made the amount of money he did last year?--that Medicare and Medicaid will not only continue, but will be expanded...

...Have you any idea how many hospitals have been built with Uncle Sam's help through the almost unknown Hill-Burton legislation, or how many additional doctors have been trained through government subsidies to medical schools...

...The $38 billion saved that way would come to about half the projected Carter budget deficit in fiscal 1978...

...J u s t abolish Medicaid and Medicare...

...Leukemia is financially expensive today because for many forms of the disease patients can be kept alive and even functioning fairly normally--often for many years after the disease strikes...

...And it's quite clear what happened in 1966...

...The availability and use of new medical services account in part for rising spending...

...All that was in the bad old days...

...But of course all that's an idle dream...

...His truss didn't seem to be inconveniencing him any...

...What this suggests therefore is that the proper role of government in health care financing is just one: To encourage as many people as possible to get catastrophic insurance, meaning insurance that will compensate them for medical costs that go above some significant percentage--15 or 20 percent say--of a family's income...

...No such villainy will take place if the FTC has its way...

...In that very same Carter budget message quoted above, it was announced that Medicaid would be expanded still further by setting up a new screening program that will expose 14 million kids--not just 12 million as at present--to the risk of becoming hypochondriacs by sending them to doctors and nurses when they don't feel any pain at all...

...Your friendly local GP might even call you up and ask if you wouldn't like a house call at a special rate--just for sociability, even if there's nothing detectably wrong with you...

...What it all adds up to is that government is behaving in its usual Janus-faced fashion...

...Did that 90-year-old lady really need to be in a nursing home...

...Kidney disease killed fast in the old days...

...And if occasionally we called a private doctor, he not only came but apologized for asking for a $2 fee...

...There has to be a watchdog, something some people would call the Death Committee while the Nice Nellies would call it the Optimum Medical Use "of Resources Committee...

...s The Future That Doesn't Work...

...That awful possibility and its implications for hospital costs don't seem to have occurred to the would-be regulators...

...Should Jim Smith really have had that hernia operation...

...Leukemia was cheap 30 years ago when nothing could be done and the patient died more or less promptly...

...The Federal Trade Commission is striving with might and main to protect me and you and you and you...

...The FTC is worried that one of these companies might want to advertise that its tablet or pill or lotion or cream or whatever might be good for the blahs or for the trots or for that horney feeling you get every once in a while...

...But who can afford to pay current hospital bills at the rates to which they've been driven by insatiable demand born of Blue Cross and other third-party-payer inspired inflation...

...So the future looks good for medical bureaucrats, for medical inspectors, for medical policemen, for medical computer specialists--in short, for the whole army of paper pushers that a vast and complex government organization accumulates automatically...

...And here are these FTC jokers trying to prevent all the pitchmen, even the pharmacist, from telling us what's good for the blahs...

...And oh yes, we would let Rolaids, Dristan, et al...

...Nonsense...

...Medicare and Medicaid aren't going to be repealed...

...And if you didn't take those non-prescription drugs, you'd probably visit your doctor and start chipping away toward the point at which catastrophic medical insurance would xake over...

...Kevin Cahill, Democratic Governor Hugh Carey's health dictator for New York State, told me some time ago that New York is forking out about $35,000 a year to care for every one of the retarded patients at infamous Willowbrook-but even that is not enough, as every new expos~ of the conditions at Willowbrook reveals...

...The other face is perpetually frozen in a snarl born of ceaseless complaining that it costs too much...

...In the official demonology, it's the inefficient hospital managers and the greedy doctors...

...Although he had always been a most private person, resenting the intrusive demands made by other Americans on his time and energy when he was a "public" figure, Lindbergh always had a secret love affair with his country...

...What we do about the blahs, the trots, or that homey feeling will be our business...

...Ye gods, such subversive reasonifig might even lead one to blame Congress and the President, who are taking the bows for today's free medicine and looking forward to taking the bows for tomorrow's free medicine...

...But of course this scheme can be abused, too, After a family has passed the threshold percentage of its income, the care it receives is "free" and the door is wide open for all the old abuses...

...Another name for this mechanism is catastrophic health insurance• The basic fact is that most Americans are healthy most of the time...

...Now we're creating Health Systems Agencies--and bow low when you pronounce the magic letters HSA--and they're going to plan the medical system of each part of the United States...

...More important they don't cost very much...

...And, of course, if we go far enough down that road, we'll have two medical systems just as in the Soviet Union--one for the proles, the majority, and the other for the ruling minority...

...Of course, if you're paying your own hospital bill, you can stay as long as you want to...

...Harry Schwartz Plop Plop, Fizz Fizz What government should and shouldn't do about medical costs...

...But there are no votes to be garnered by promising people you'll pay their medical bills only if they suffer a catastrophe...

...Total national health expenditures grew from $42.1 billion to $139.3 billion during the same period...

...Sold by all druggists a t 50 eet,t~ or by The DR...

...Hasn't anybody told them about the First Amendment...

...claim they combat the blahs...

...How could I even think of such an awful idea...

...He converted her, not vice versa...

...Apparently something dreadful happened in 1966 which unleashed the inflationary monster...

...If you expect him to be interested in your troubles and really do something about them-you'd better figure out a way to slip him a supplement the way wise people do in Moscow and Prague...

...But nobody should have any illusions...

...All this, of course, is under the flag of avoiding waste and needless duplication...

...That's easy...

...Every pharmacist I've ever met is prepared to give you an instant diagnosis of your version of the blahs and to suggest one of his better profit margin non-prescription remedies to do what needs doing...

...But price and wage controls in medicine--for that is what the Carter Administration has in mind, whatever the terminology it employs--won't do the trick...

...DR...

...For a starter they're going to focus on hospitals and the like, but down the road one can see these eager 8 The Alternative: An American Spectator May 1977 planners deciding how many dermatologists Flatbush or Matin County is entitled to and where they may have their offices...

...You know, the people who put announcers to such tasks as putting tablets in glasses of water and pronouncing poems of purest ecstasy over the fact that tablet A dissolves one-tenth of a second faster than tablet B. Yes, it's the over-the-counter drug industry, the good people whose cheap products save us so much money every year in avoiding visits to doctors and hospitals...

...None of this is new...

...There is no need to set up a monstrous "free" medical system without any incentive for patient economy...

...The average American family can afford to pay out of pocket normal medical expenses...

...For sick people and those who try to take care of them things don't look so good...

...Have you ever heard of a Professional Standards Review Organization (PSRO to the cognoscenti...

...And it usually works, I've noticed...

...No, Medicare and Medicaid are safe...

...The notion that the troubles begin with "free" medicine in the first place because the consumer has no motive to economize must of course be rejected out of hand...

...t can be built on a simple principle: The important thing is to help people who really need help...

...Carter has already announced a " c a p " on hospital costs which have been going up 15 percent a year, but are henceforth to be permitted to go up no more than 10 percent a year...

...Amusingly, Scott treats his monkeys in the family tradition, letting them go out from protected quarters "into the nature" ("clans/a nature") as they please...

...Even when he had to flee to England to protect his family, he knew he would be coming back...

...Practically every hospital belongs to one, and it's the job of the PSRO nurse to see that you get thrown out of the hospital as soon as possible--at least if the government or an insurance company or a Health Maintenance Organization is paying your hospital bill...

...The head reels to think of the millions of dollars being spent on lawyers' fees alone in these incredible proceedings...

...And what happens if the cost of living goes up more than 10 percent a year...

...But people who ask such questions don't realize I'm such an old duffer that I can remember what it was like before Medicare and Medicaid...

...No, the way we save money on health costs these days--and on this there really is no difference between the Nixon, Ford, and Carter Administrations--is by means of price controls and policemen...

...There's nothing like a sharp decline in business, after all, to make people much more reasonable about price and delivery conditions...

...Moreover it's ihaportant to cut out fraud, and even the village simpleton knows by now that the freer medical care has become in this country, the more crooks have supped at the Federal treasury's trough...

...But anybody with a micron of intelligence knows that aspirin and Dristan and Rolaids and the kindly pharmacist who sells them are the most effective weapons we have to date against rocketing health care costs...

...Who's to blame...

...The method is simplicity itself...

...Harry Schwartz, author of The Case for American Medicine and many other books, contributed as essay o. British health care to R. Emmett Tyrrell, Jr...

...Their turn will come...

...And to secure that goal, the bribe to tile states for participating is being upped to 75 percent of the bill...

...There were never "two Lindberghs," and in this year of the golden anniversary of a pioneering flight, it is time to put the old cliches to sleep for good...

...But in all these cases the patients would begin with some incentive to economy because they would have to pay the first dollars of medical care...

...For those wbo've forgotten, Powell's Law is the piece of common sense which points out that there is an infinite demand for " f r e e " health care--or at least for health care paid for by somebody other than the beneficiary...

...A few are professional sadists and spoil sports or secret members of the Women's Christian Temperance Union or one of its fellow-traveler organizations who think the high cost of health care is the lever that will get the old 18th Amendment and glorious Prohibition reinstated...

...After all she does have an apartment on the top floor of a five-story walkup tenement...

...WHITEHALL'S RHEUMATIC CURE ELIEVE$ RHEUMATISM I f yOU wish to t r y It we w i l l ~end you s 'u"mple without cost...

...The real problem is that posed for people who have severe illness for which something can be done...

...We always went to the nearby hospital clinic where the standard fee was 50 cents...

...Nevertheless much of the increase has resulted from health cost inflation...

...The forces of evil against whose machinations the FTC is struggling so fiercely are those friendly folk who do so much to support television, the networks and the independent stations both...

...And that local general hospital which is collecting $200 a day from Blue Cross every time you go in to have your heartburn investigated might run a sale--you know, $25 a week in a private room for a honeymoon couple and nobody will ask you for your marriage license...

...But the people who talk this way are usually very healthy, and besides they see chances for getting better jobs or bigger research grants as part of the push to cut health costs...

...But the HSA's waste may be that hospital around the corner you've been accustomed to going to...

...The ultimate aim of the present Washington policymakers, after all, is National Health Insurance...

...And that goodie, the ordinary guy and gal think, means that everybody gets all the health care he or she wants whenever they want it...

...So more and more we'll have policemen overseeing the medical system, policemen working for HEW's new Inspector General or his local counterparts in state and municipal and county governments...

...I t CoQts noti)tuZ to t r y the remedy t h a t g~ves result& Write to-day for a trial tmx...

...One face is promising us new wonders of free medical care, with the hint that even immortality may be down there at the end of the road as the result of some marvellous discovery by the National Institutes of Health scientists...

...First the screws are applied to the hospitals, and then, that task finished, out will come the national fee schedule or whatever the Carter Administration will choose to call it...

...Some way to save money...

...I begin with this remarkable event because the chief topic of health conversation these days is no longer the grim toll taken by cancer and heart disease or something serious like that...