On new proposals in health care
Goffman, Ethan
The disruption caused by our chaotic medical systern has reached such proportions that mainstream medical thought is beginning to call for a major revision of health services. As costs sprout...
...The January 12, 1989, Journal contains two proposals for reform...
...It'll save you a few bucks, it'll mean getting the magazine in the mail—but at least as important, it will mean that, with less cost to you, our income will get a little boost...
...The new system would be beneficial both in terms of financing and fairness...
...With national standardization, billing would also be greatly simplified...
...Meanwhile wealthier patients with superior coverage may receive unnecessary treatment solely to line the pockets of unscrupulous doctors...
...All funding would be channeled through a single pool, which would set budgets for all hospitals and nursing homes...
...Long-term funding would be provided to those hospitals and services that showed greatest need...
...But if you'd like to help us and make things more convenient for yourself: Please subscribe...
...This proposal, endorsed by over four hundred doctors from across the country, makes clear why physicians support a program that seems to contradict their financial interest, that is, why our current health system is failing...
...Centralization is the key to the "National Health Program...
...Only drastic measures can "repair or replace our present disastrously inadequate health care financing system...
...SUMMER • 1989 • 293 Comments 8 Ophdone October 6, 1988, Plaza D'Italia, Santiago, Chile: "No" Vote supporters take over Plaza after Pinochet government concedes defeat during plebiscite...
...In our current political climate, such terms are forbidden—indeed pains are taken to deny their applicability...
...The argument that a free market maximizes efficiency and productivity (however inequitable its allocation) is turned on its head...
...So, please...
...Conspicuous in this proposal is an avoidance of the words "Socialized Medicine...
...With the profit motive removed, hospitals and physicians would have no incentive to skimp on or allocate care unevenly...
...As costs sprout upward the already limited care for low-income patients is further eroded while the middle classes increasingly feel the squeeze...
...And enough boosts would make things decidedly easier for Dissent...
...Yet parallels with the European welfare state, and with even older socialist ideals, are abundantly clear...
...So their diseases are treated at a late stage, causing unnecessary suffering and expense...
...This echoes the words of a certain nineteenth-century economist, "From each according to his ability...
...Arnold Relman, the influential editor of the New England Journal of Medicine, suggests that "we urgently need a new and more comprehensive approach to health policy...
...The New England Journal of Medicine can be obtained by writing to 1440 Main Street, Waltham, MA 01254-1649...
...By contrast, overhead accounts for roughly 8 percent of private insurance costs...
...Ricky Flores/IMPACT VISUALS) 294 • DISSENT...
...Our medical treatment system also costs more than systems that deliver superior care...
...The second, of more interest to Dissent readers, calls for a national health-care system, funded through mixed sources but ultimately channeled through the federal government...
...Canada's national health system, as well as our own Medicare system, spends only 2 to 3 percent of its budget on overhead...
...The plan states that "access to care should be based on need rather than on age or ability to pay...
...Inequalities in treatment due to unjust distribution of medical facilities and ballooning costs discourage low-income patients from seeking timely preventive care...
...In some circumstances, it seems, centralization provides better service at a better price...
...Relman argues that "neither [plan] represents the socialization of health care because the government would not own or operate health-care facilities or employ physicians...
...The multiplicity of private insurance companies creates duplication of paperwork and excessive bureaucracy...
...The first is relatively decentralized, based on competing health plans and mandatory coverage through employers...
...Traditional American hostility to government ownership leads to some convoluted methods of sneaking in all the features of socialization while avoiding the term itself...
...To Regular Readers Who Don't Subscribe We're glad, very glad, to have you...
Vol. 36 • July 1989 • No. 3
