National Health Care: Solution or Disaster

...A growing, costly government When a need developed in the medical skyrocketing, bureaucracy develops, with increasing field for a high standard measurement power to decide who will receive care tool which would help judge a medical The Proposed Solution and how much, which drugs may be used student's degree of attainment in mediand which are "too expensive," what cal knowledge (the state exams were So there is the problem: the destruc- surgery is necessary and what can not doing the job), a group of doctors tion of the market mechanism and the "wait," which institutions will get funds worked to establish the National Board consequent imbalance between supply and which will not...

...The resulting Medical care becomes increasingly un- vices available has mushroomed beyond inefficiency and higher cost had to be available since it is a limited resource belief, along with the standard of living...

...The methods chosen for licensing medi- cine, however, are so far from guaran- teeing quality care that many people today, particularly medical educators, are seriously questioning their value...

...Any time demand or to get into a hospital...

...In this case, the amples, many operations are delayed been a consumer need for them...

...Costs at the best possible price...

...the White House believes that the debate over the impoundment of Federal funds has been turned into a rhetorical bandwagon for would-be (and not-so-would-be) pres-idential aspirants...

...In fact, during the Kennedy Administration, Ash pointed out, the impoundment of funds averaged 6 percent of the total unified budget between 1961 and 1963...

...Since the status quo able to perform...

...But Mussolini and Hitler and dictators in South Vietnam, South and North Korea, Spain and South America, and in little nations of despots all over the world...

...many medi- cal schools give the exams to their stu- dents as an evaluation of the success of their teaching...

...were only 69 a 57 percent loss in This raises an essential moral issue: Within this bureaucratic straitjacket, thirty-four years...

...That goal will be reached by the individual's own efforts, and by health education (although not of the ineffective kind on which the gov- ernment is currently spending millions of dollars), as much as (maybe more than) by better, less-expensive medical care...

...The artificial walls have been built around the field of medicine in an attempt to improve the quality of medical care...

...in other states, the score is relatively low, and eight to ten years will pass between failed candidates...

...National Health Care: Solution or Disaster Medical care costs are rising, and a fearful howl is out for government to "do something...

...James Abourezk, watch out...

...Not many here in this land today...

...Anthony was expanding steadily, man's "need" give him a "right" to Lejeune in his booklet "Socialized MediMeanwhile, legal barriers were re- medical care...

...we have progressed beyond govern-ment's ability to cope...

...Services become swamped...

...Some states require a relatively high score, with as many as 40 percent of the candidates failing many years...

...For years of the fruit of his labor...

...According to Derby-shire, at least two states frankly design their exams to "keep the number of physicians at a level optimal to the establishment...

...4. stopping smoking...

...So the free market not only offers the most and best alternatives, it also offers consumer protection...

...State boards-do agree that a candidate should pass an examination before being li-censed, but they cannot agree on the subjects that should be included in the exam...

...A self-feeding circle of stagnasqueezed by law, the Federal govern- many-fold, as happens any time a good tion, inefficiency, and rising expenses ment further compounded the personnel or service is offered at a lower price develops...

...The results have always been the the services they need and want, and or services existed already and the pop- same...

...During the last decade Federal spending on domestic programs alone has increased 220 percent...

...Most proposals want the government skill is in maintaining favor with The result was that, where there were (i.e., the taxpayer) to pay al~ or part government, or in remaining on civil 162 medical schools in 1910, by 1944 there of the bill...

...At least not as I read the real issues now before us...

...While all of his acquaintance sneered and slanged, ! wept...

...The absurd situation has therefore developed that what is considered "quality" in one state can he branded "illegal" in another...

...States also vary widely on the scores necessary for passing licensing exams...

...But is it any different to force crowded, understaffed hospital conditions physicians to perform many activities one man to pay for another man's medi- in Britain, an equivalent of one-third which could be performed as well, often cal care than, say, to force him to pick the entire annual output of doctors from times better, by other personnel at a another man's cotton...

...Changes come for those who While the supply of medical schools, demand on health services...

...paid for...

...Since 1973 is not even a political year it can be expected that the political demagoguery coming out of the nation's capital from Democrats and Republicans alike will yet reach even greater pro-portions...

...Toward this end all states regulate and license the practice of medicine...

...Watch your television...the pushing, shoving and villification (sic) that surrounds anyDiane Alexander one who stands for office...The pushing and shoving and the shooting...

...At $269 billion it is probably the most expensive bone in history...

...A bewildering proces- sion of solutions is being proposed, everything from organized labor's womb- to-the-tomb medical coverage (costs to be borne by taxes), to President Nixon's partly self-paid, partly tax-paid cov-erage...

...The steam to the engine of inflation, as economists of all creeds recognize, is and always will be irresponsible Fed- eral government spending...

...I deserve until I am defeated, impeached, or shot, your respect...

...It isn't only Democrats who liven up Capitol Hill, however...

...They do not guarantee quality to the layman...

...However, the reduc- tion of the price for treating sickness and disability will not alone solve the problem completely...

...Everytime you ask a senator, or any elected official 'Who do you think you are?' you fire a bullet at George Wallace or Robert Kennedy...you assault the fabric, the very soul of this republic...

...Hopefully we and the government will soon recognize that it is just as much an infringement of an individual's rights when the gov-ernment prevents him from going to the Letter from a Whig practitioner of his choice (whether M.D., naturopath, witchdoctor, or other variety of medical practitioner) as when a quack fraudulently sells metal rings as a cure against terminal cancer...

...A watchdog is always Consumers Union, Better Business services, the remainder of those costs needed to minimize fraud, extravagance, Bureau, and Underwriters Laboratory had to be passed on, too, to the paying and other misuses by both patients and developed to provide that help...

...So part of the solution to the prGblem with which we are currently faced is the freeing of the medical field from government control...

...The Impoundment of Funds The Administration's congressional critics are particularly sensitive to what they charge is the President's usurpation of their power, (the "impoundment of funds...

...The first people they kill, jail and torture are journalists and lawmakers...

...Instead of having of Medical Examiners...

...cally-appointed bureaucrats whose main tors" and thus a "lowering of quality...

...for I had longed to see him hanged...

...Yet no two state boards can agree on what constitutes quality medicine...

...Instead, the yell loudest or have the most influential doctors, and other personnel was being proposed schemes will increase demand friends...

...Robert C. Derbyshire, M.D...

...Roy Ash argued that the im- poundment of Federal funds by the Chief Executive is one of the oldest traditions in American history...

...they are prevented be- pointed doctors has gained over the prac- is politically the safest route, few cause it is so excruciatingly difficult to tice of medicine...

...However, it is true that whether we have a free market or a governmental system of medical care, there will always be some low quality medicine and outright fraud being practiced...

...Artificial walls have been built around medicine, individuals are pre-vented from entering the field, incen-tives for private cash flow have been eliminated, and yet demand for services has been artificially increased...

...In 1910, the government began moving to close down some medical schools while restricting enrollment in The Alternative June-September 1973 others...

...But inflation clearly remains the nation's number one problem...

...It results in a population which shortage by subsidizing medical re- (other things being equal), must spend much of its time yelling or search...

...This is not physician ignorance or care- lessness...

...servant lists with tenure for life...

...But in a statement by the Dir- ector of the Office of Management and Budget before the House Committee on Rules, Mr...

...5. stopping abuse of drugs and alcohol...

...Derbyshire counted a total of fifty-nine different required subjects, many ridiculously obsolete, yet still re-quired by law...

...That is an enormous amount of power, and yet these board members are chosen, not for their medical qualifications, but for their medical-society or party politics...

...These figures represent 70 percent of all the impounded funds, and it means that only 30 percent comes from human resources...

...Hospitals and patients cians' assistants...

...The ultimate responsibility for the maintenance of any individual's health under any system of medical care will The Battle of the Budget "Money," said a recent congressional newsletter, "is what the war in Washington is all about today...

...V3 remarkable when one considers that 37 percent of all impoundments come from the highway trust fund, 25 percent from the budget of the Defense Department, 6 percent from miscellaneous areas such as space, research, and technology...

...Misplaced National Priorities...

...In contrast to and demand, quality and cost...

...The laws which establish this shoddy screening definitely regulate and mold the practice of medicine, and yet those laws are arbitrary, capricious, and chaotic...

...The Republican National Committee headquarters, widely regarded as a staid, socially conservative bastion, recently was given a no-liquor on premises" ultimatum by Chairman George Bush, who apparently stumbled on an afternoon post-cocktail party featuring a touch football game between GOP staffers...

...Watching the early rounds in the battle of the budget one is struck by the claims that Nixon has slashed Federal programs to the bone...

...The Causes of the Problem Today's increase in hospital costs comes primarily from a recent steady rise in salaries of health and medical personnel, a rise which has resulted mainly from a scarcity of personnel in relation to demand for their services...

...Instead of guaranteeing better quality medical care, the mishmash of anti-quated laws retards progress by pro-hibiting or discouraging innovations in medical-school curriculum and medical- care practices...

...It is all a pattern...

...money, medical schools began spending more staff time on research and less The Alternative on teaching, thus aggravating the problem...

...This in-flow continues until demand is more or less satisfied, then the magnet loses its strength as profits decrease...

...In order to make fast strides toward im- proving health, we don't need more doc- tors, medical research, or fairy god-mothers to pay the bills, we need to refocus on what we are trying to ac-complish --maintenance of good health...

...Concluding his discussion of the matter on an optimistic note, the Senator reminds us ~'I am an elected lawmaker...

...The reason is not hard to find: the free market and its balancing mechanisms have been de- stroyed...

...They keep that watch in order to maintain the good name of their institution...

...Senate Republican leader Hugh Scott's somewhat cynical statement serves to illustrate the point: "Asking the Democrats to control government spending is like having an alcoholic for your bartender...

...Despite their minimum qualifications, these board members are supposed to choose "good" medicine for their state while banning "bad...

...complete removal of government from To compete for a first-rate staff, hospital meddling with the problem it has caused administrators were forced to offer in- in the first place...

...The final score was not announced...

...if The patronizing excuse with which in the form of higher bills, rationing is not done on the basis of government undertakes so many of its Finally, in 1966-1967, the crowning blow money, it must be done on the basis of activities on our account, "The layman to hope of lowering health care costs time...

...And I intend to have it...

...The slogan "Health is cine Showcase of Failure" reports that stricting the proliferation of other medi- a right, not a privilege" argues this point with the low pay and depressing, overcal professions, allowing only licensed of view...

...Why, then, has this influx of personnel and cash not occurred in the health services field, filling the current short-age and satisfying demand...

...it was passed on to patients and must be rationed in some way...

...The Ad-ministration, in short, is taking the position that there is no "constitutional" or "impoundment" crisis...

...in his book Medical Licensure and Discipline in the United States describes the current physician licensing practices...

...And who agrees with me...

...Members have not achieved academic attainments, many are even extremely outdated in their field...

...The more we encourage individuals to evade realization of this responsibility, the farther we will be from our goal of reaching each individual's potential optimum health level...

...We will be hurting our- selves by halting the brilliant along with the fakes...

...Let us en-courage men to be responsible for them- selves and their own lives, not chain them to the past while saddling them with the ever increasing burden of pay- ing other people's medical bills...

...Then, waiting lists with hundreds of thousands created a consumer need for help in because government reimbursed medical of names...

...And finally, most ominous of all: "Go on the campaign trail with me...

...multiplied overnight...

...So let us remove these arbitrary, damaging governmental restrictions and allow new institutions and personnel to develop...

...Especially in today's complex society, government cannot be our watchdog...

...Does a poo~ search of better opportunities...

...Your last bulwark against dictatorship...

...it is a result of the ignorance of medical science today...

...nor will they encourage changes are made unless there is some remove laws from the books once they a proliferation of alternative types of special-interest group hollering forhave been passed, care and personnel...

...Although various legislative proposals are currently being considered which would ameliorate the current budgetary process, recognition has not always been the father of reform and there is, un-fortunately, no...

...Here is the sphere where government can legitimately take ac-tion --when an individual's rights have been infringed and there is a need for the redressing of injustice...

...if it doesn't work, come back and see me...

...3. exercising sufficiently...

...No wonder medical bills were doctors...

...2. eating nutritiously...

...Thus with a Federal budget that is over 70 percent uncontrollable and with pros-pects of even higher taxes it would seem that the Nixon Administration has all the ammunition it needs to win this battle...

...It makes no sense, therefore, to create rigid rules, then eliminate practitioners who do not conform to them...

...Under the free ulation base was too small to support skyrocket beyond anyone's expectations, market, the number of goods and serthem all economically...

...The more government monopolizes 'right" to take temperatures and blood In addition, forcing the taxpayer to control of medical care (as they will if pressures...

...The results of giving the state authorThen the Federal government enacted ity over medical care are inevitably the Hill-Burton Bill which encouraged devastating...

...That is some-thing very special.' "He meant, of course, that the office of Senator was special, for it is, in his words, "as destined, to purpose (sic), to mankind (sic), to good for mankind as any poet, artist, inventor or philosopher-prophet (sic...

...In Great However, the free market has developed increases, costs will increase unless the Britain and Sweden, two excellent ex- protective devices whenever there has supply catches up...

...In these, and many None of the current national health care compete with one another and with other instances, personnel are being pre- schemes will eliminate the strangle hold schools, highways, and defense for vented from using skills they are well which a small clique of politically-ap- scarce tax funds...

...The government has affected the amount and cost of medical care in more ways than just the licensing of physi- cians...

...And indeed, the battle of the budget between Congress and President rages on...

...All of which recalls Hilaire Belloc's brilliant poem, "Epitaph on the Politician Himself": Here richly, with ridiculous display, The Politician's corpse was laid away...

...Doctors hare to cut down on the is ignorant and does not know how to was delivered when Medicare and Medi- time they spend with each patient, and take care of himself," is often true, since caid were created...

...It has been esti-mated that our hospitals could be emp- tied today by as much as 50 percent of their patients (thus lowering the cost for medical care by millions of dollars per year) if individuals protected their own health by: 1. wearing seat belts in their automobiles...

...nurses had to fight to gain the legal tionable on moral grounds...

...choosing wisely between the vast array facilities for only a percentage of the However, this rationing of resources of alternatives, organizations such as the costs incurred for Medicare-Medicaid is never enough...

...The physician makes recom- mendations to the patient, but has no power to enforce them...

...it is the individ- ual who must decide "Yes" or "No," "I will take this pill," "I will stop smoking," "I will have this doctor per- form this operation...

...centives --higher salaries were paid, The free market has always woven expensive equipment was bought, and of subsidized medicine to examine and itself vastly superior to any governmenadditional services were set up (often learn from, in our own and other coun- tal activity in providing individuals with in areas where other such equipment tries...

...nor will they lower change...

...The present debate over the impoundment of funds is all the more always rest squarely on that individual's own shoulders, not on the state's or the physician's...

...Today, army medics are pay the bill for the high cost of medical they are paying the bill), the more fighting for the "right" to act as physi- care will only compound the problem, politics is played...

...They do, however, set the practice of medicine in a form as unyielding as concrete because, while knowledge may change rapidly, laws do not...

...The laws were created to discourage quacks and the mediocre, yet both flourish after more than sixty years of regulation piled upon regu-lation...

...Both rob the man medical schools migrates to other small portion of the cost...

...Knowl- edge of the human body and its reactions is still too miniscule, despite recent almost-miraculous advances...

...reason to believe that the Ninety-third Congress will be able The Alternative June-September 1973...

...Any time a service or commodity falls into short supply, costs (and thus profits) will rise, acting as an effective, built-in incentive to increase supply by at-tracting people and cash into the field...

...When supply of medical care was still expand- months or years because hospitals have the mushrooming of goods and services ing slowly, so costs stayed up...

...patient...

...Many leave the country in slowly, at a time when the population to pay for his medical care...

...Under President .Johnson the figure fell to 5.4 percent and President Nixon brought the level even lower, to 5 percent between 1969 and 1972...

...There is a very simple reason for these results: there can be no "one way" to practice medicine which government can bottle up into a form of license...

...In each state a small, government-designated group of doctors (the state's Board of Medical Examiners) is the final arbiter as to which medical schools may set forward their students as candidates for licensing exams, which individuals may practice within the state, and how many physicians that state will have...

...Demand for services patients must wait longer to see a doctor none of us is an expert in every field...

...The Nixon Administration plans to use the parliamentary whip on its Republican troops for what it considers some fifteen "budget busters": i.e., appropriations bills which the Administration claims would cause a tax increase and fuel in- flation...

...the solution to our current the building of more hospitals...

...The output of doctors Does any individual (or group of indi- the best doctors become restive and diswas thus decreasing, or growing only viduals) have a right to force another couraged...

...Ash further claimed that as of Jan- uary 1973 Nixon's impoundment average was at one of the lowest levels in the last fifteen years, 3.5 percent...

...In order to gain this government We already have scores of examples suffer the consequences...

...With problem, therefore, is not more and more hospitals, there naturally devel- better (or Federal) regulations, it is oped a need for more medical personnel...

...When it comes to protecting the lay- man against "bad medicine" one of the best devices that exists today is not the licensing and regulating of government, but the close, careful watch which rep- utable hospitals keep over the work of their staffs...

...To ensure that we choose the best possible alternative, we must go back and discover exactly what has caused the current steep rise in costs...

...They agree with me...

...both are ques- countries...

...Waste was added to inef-ficiency because Congress lacked the means for a constant and systematic review of existing programs...

...The confrontation over the Federal budget has quickly become (with only rare exceptions) a hotly debated partisan issue...

...Yet the a doctor making medical decisions the exams of the state boards, the solutions being proposed in Washington (which he has spent hard years of study National Board's exams have no legal today hinge mainly around one idea: learning to make) that power is more standing whatsoever, and yet they are The Alternative June-September 1973 15 highly respected throughout the country as a certification of ability...

...And just because that elected official does not know who he is, or otherwise abuses his office, that is no excuse for the questioner...

...The prac-tice of medicine still consists of a large amount of trial and error, as can be seen by the fact that many physicians tell their patients, "Take this pill...

...That reputation is something they must work hard and constantly to maintain...

...Then we have the best chance of choosing alter- natives which will eliminate the real problems, and encourage progress in the saving of lives...

...This was done to protect the find someone besides the recipient and more placed in the hands of politipublic from an "overproduction of doc- of medical services to pay the bill...