Group Medicine's Big Test

...True, every time an individual joins a prepaid medical plan, a prospective customer is taken off the open patient market...

...What action is the AMA likely to take at its San Francisco convention...

...4, Proration of fees is not unethical if both physicians or surgeons actively participate in providing medical care and if the fee is paid by an insurance company...

...Thus, HIP and similar comprehensive prepayment medical-care plans across the country make it possible for doctors to engage in a form of private enterprise that rewards them professionally and financially while it benefits the general public...

...Alfred P. Ingegno, Kings County Medical Society president and leader in the "clarifications" fight: "Naturally, the idea of letting subscribers go to any individual doctor or group of doctors is going to hit present HIP doctors right in the pocketbook...

...With the help of philanthropist David M. Heyman and a prominent lay group that included Winthrop W. Aldrich, Gerard Swope, Beardsly Ruml, the late Alfred E. Smith and Wendell Willkie, HIP was finally set up as a private, non-profit organization...

...The plan now has 29 such centers, and another is under construction...

...The Committee was taking testimony on two bills supported by President Eisenhower and sponsored by Representative Charles A. Wolverton (R.-NJ...

...In reading the Supreme Court's opinion...

...Although the AMA may deny responsibility for what almost amounts to a door-to-door advertising campaign by some of its members against group medical practice, doctors are attending Parent-Teachers Association meetings and other civic gatherings to discourage support of such plans...

...he would normally wait until his illness became really serious before visiting a doctor...

...the other would grant Government mortgage insurance to prepayment-plan medical centers...

...An examination of HIP's origins and operations is thus very much to the point...

...To get into the plan, one has to be part of an establishment already belonging to it or a new unit that wants to join...

...For three years, too, a City commission studied ways to remedy the situation...

...He discussed the problem with his personal physician, Dr...

...Their savings of $1493,500 were not enough to build it, however, and they eventually secured a 20-year $250,000 mortgage at 4 3/4 per cent from a "forward-looking insurance company...

...In his January 14 health message to Congress, President Eisenhower noted: "There are...

...Trust-busting Thurman Arnold, then an Assistant Attorney General, initiated proceedings against the AMA and its local society, and in 1943 the Government won a decisive 9-0 victory for the GHA...

...The late Mayor of New York, Fiorello H. LaGuardia, was deeply concerned over the fact that city employes in lower- and middle-income brackets often suffered financial ruin when serious illness struck...

...This is to be contrasted with 126 physicians in the West, 116 in the North Central area, and 92 in the South...

...At its own expense, the group is also responsible for providing a medical center which generally operates as an outpatient clinic that meets HIP's standards...

...Perhaps one of the best features of plans like HIP...

...And a report just released in Washington states that the country is faced with a severe doctor shortage...

...Of this number, approximately 275,000 are civil servants and their families, but the number of non-municipal units participating in HIP is growing steadily...

...HIP's Division of Preventive Medicine and Health Education is constantly prodding subscribers to collect their medical money's worth...

...This is particularly so since the Judicial Committee is likely to report that the courts will declare them unenforceable...

...2. The practice of medicine by physicians on a salary "is ethical only when such diagnosis and treatment is for a patient who is a public charge...

...It began operations in 1947 with 71,000 City-employed subscribers...

...When the Group Health Association of Washington, D.C...

...In tribute to them, the Committee placed their names in the record...

...Group Medicine's Big Test By Myron Kolatch nder the guise of cutting out a "cancerous growth," American Medical Association affiliates across the country are searching for ways to kill off prepayment group medical plans...

...3. Free choice of physician, a requirement of the present code, is vitiated if the patient is required to choose a physician from a panel or group of practitioners...

...The time for aggressive treatment is now, and it demands a bold attack...

...and Seattle, Washington, Labor Health Institute of St...

...Justice Owen J. Roberts said: "The indictment devotes many paragraphs to a recital of the plan adopted by Group Health and alleges that, principally for economic reasons and because of fear of business competition, the defendants have opposed such projects...

...For each person under its jurisdiction, a group receives $29 annually from HIP...

...however, is that they thrive on keeping people well...

...Sinai Hospital, past medical director of the U.S...

...Representative John W. Hesselton (R.-Mass...

...Some foot the entire bill...

...To qualify, a group must have a minimum of 30 physicians, including specialists in medicine's twelve basic fields...

...Since the Supreme Court today seems keenly aware of the necessity for social advance, it probably would not now turn the wheels of progress into reverse...

...It is logical for the New York delegation to be spearheading this offensive, because HIP is considered the country's outstanding comprehensive-care plan and a leading proponent of the group-medicine idea that made the Mayo Clinic famous...

...Each of these is a self-organized medical partnership that has voluntarily sought HIP affiliation...

...many are newly built, some were bought and reconverted for medical purposes...

...Louis meeting last December the following warning was issued by its Judicial Council: "There have been instances in which a state association or a specialty organization has announced an interpretation of a segment of the Principles of Medical Ethics which is definitely contrary to that adopted by the American Medical Association...

...Baehr: "I should like you to list the name of every doctor who contributed so wonderfully to the success of your effort...

...John R. Garlock's May 24 address as retiring president of the New York County Medical Society: "I don't want to sound like an apostle of gloom, but, as far as I can determine, the handwriting is on the wall...

...The real answer to the above question can be found in a statement made by Dr...

...159 practicing physicians for every 100,000 of the civilian population in the Northeast United States...

...The 400,000 people it insures are cared for by 30 medical groups strategically located throughout the metropolitan area and Nassau County...

...The most recent and effective move to shift medicine into reverse was negotiated last month, when the New York State Medical Society's House of Delegates adopted the following "clarifications" of the State Code of Ethics for physicians: 1. Advertising is unethical if it aims at enlisting patients for a panel of physicians of a medical-care plan, company or other organization...

...In truth, the petitioners represented physicians who desired that they and all others should practice independently on a fee-for-service basis, where whatever arrangement for payment each had was a matter that lay between him and his patient in each individual case of service or treatment...

...Walter Martin cited Article VI, Section 4 of the Principles of Medical Ethics which was re-approved by the AMA's House of Delegates in December 1953and indicated that free choice of physician was not an ethical requirement of medical-service programs for which a prepayment plan or other third party legally assumes the cost...

...From its general practitioners, he selects a family doctor, whom he may call to his home or visit in the office as frequently as he desires...

...Richard M. Carey, Upper Manhattan Group director, testified that for a full year all earnings, and for another 3 1/2 years half of all earnings, were put in a building fund...

...Considering the financial investment that a medical partnership makes, it has a vital stake in satisfying its patients...

...In view of these facts, it seems that the national organization will probably try to discourage adoption of the New York delegation's "clarifications...

...By protecting their members' incomes, therefore, medical societies are actually inflicting hardship on a large segment of the population...

...Since 93 per cent of the families covered by HIP earn considerably less than $6,500 a year, it enables them to enjoy more medical care than they ever could afford before...

...A firm then put up 24 per cent of the cost for a $450,000 structure, requiring the personal security of each physician...

...How this is divided depends on the group itself, but, as a rule, general practitioners get a certain yearly fee for every individual under their care and specialists are given a stipulated sum...

...The fear that stems from the latter's rapid growth across the nation was pointed up in Dr...

...Today, it provides general practitioners, specialists, surgeons, X-ray diagnosis and treatment, physical therapy, diagnostic laboratory service, visiting home nurses and private ambulances for 400,000 people...

...In 1948, the New York County Medical Society added its good wishes by issuing a similar ruling, but this was rescinded in 1952...

...As this clearly illustrates, local AMA components are now opposing prepaid group medical plans, which they once approved, for purely economic reasons...

...The adoption and broadcasting of so-called principles of medical ethics by any other process or by any other society or organization is to be condemned...

...The reasons given range from the claim that it "would result in the deterioration of the quality of medical care to our patients" to the somewhat frantic assertion that it is inconsistent with American tradition...

...They are also urged to carry hospitalization insurance, like Blue Cross, to avoid staggering health bills...

...Why are medical societies determined to destroy this type of plan...

...There are no age or physical qualifications...

...Should he require any specialized services, a specific appointment is made at the group's medical center, where the specialists see patients...

...It conducts over 100 "education' meetings each year, and special bulletins are sent regularly to insured families...

...The financial burden this places on a group's doctors was illustrated at recent hearings before the House Interstate and Foreign Commerce Committee...

...Public Health Service, and now HIP's president and medical director...

...It may be argued that medical societies have a right to protect their doctors' incomes, but there is no problem of over-supply and little demand in this profession...

...In fact, there is reason to doubt that the societies themselves really believe the line they have prescribed for public consumption...

...None stands up under investigation...

...the annual premium for this virtually complete medical coverage is $42.72 for a single person, twice that for a childless couple, and three times that sum for a family up to ten...

...In his testimony before the House Committee on Interstate and Foreign Commerce, AMA President-elect Dr...

...Usually, however, he is a person who gets financially sick when he has to pay present-day fees to cure his physical ailments...

...George Baehr, former chief of staff at Mt...

...impressed with the financial obligations assumed by HIP's doctors, said to Dr...

...All its doctors must be approved by HIP's Medical Control Board...

...When an individual joins HIP, he alone picks his medical group...

...The petitioners were . an association of individual practitioners each exercising his calling as an independent unit...

...The City pays half this fee for its workers, as do most individual firms, agencies and unions...

...This would paralyze not only prepaid medical plans in the Empire State, like those sponsored by the Endicott-Johnson Company, Consolidated Edison Company, International Ladies Garment Workers Union and Health Insurance Plan of Greater New York (HIP), but also the Ross-Loos Clinic in Los Angeles, Kaiser-Permanente Plan in San Francisco, Group Health Association of Washington, D.C...

...it does not practice medicine...

...They insist that the public must have a "free choice" of doctors, that the "fee for service" system is the only one which gives a doctor an incentive to do his best work, that various private health-insurance programs now gaining in popularity are inconsistent with our American way of life...

...in addition, every specialist must have a certificate from an American Specialty Board, hold an appointment in his specialty on the staff of a hospital approved by the AMA for resident training, or have equivalent qualification...

...These independent physicians, and the two petitioning associations which represent them, were interested solely in preventing the operation of a business conducted in the corporate form by Group Health...

...At the AMA's June 21 meeting in San Francisco, the New York delegation will urge the adoption of similar "clarifications" for the national organization's Principles of Medical Ethics...

...Actually, HIP itself merely takes care of administrative and coordinating functions...

...In addition, at the AMA's St...

...was organized in 1937, the District of Columbia Medical Society immediately ostracized it by declaring that its doctors were guilty of "unethical conduct...

...One would make Federal "reinsurance" available to private, non-profit health plans...

...While it carried only 12 such accounts in 1947, it now has close to 500 and covers United Nations delegations, tenant groups, social and welfare agencies, labor unions, large corporations and small businesses...

...Louis, and many similar systems established for twenty to forty years...

...If a subscriber is dissatisfied with his doctor, he can choose a different physician in the group or transfer to another group altogether...

...This is important not only because it gives members a free choice of 975 doctors, but because it provides an incentive for the medical partnerships...

...If it rules against the group medical plans, do they stand a chance in the courts ? The AMA's national leadership seems to recognize the fact that group-practice plans provide a valuable service and are here to stay, even though its local branches are not yet this far advanced in their thinking...

...When HIP went into business, for example, it had the implicit blessing of the AMA, whose judicial committee ruled that organizations like it could advertise...

...Robert E. Rothenberg, director of Brooklyn's Central Medical Group, testified that, from 1947 to 1952, he and his associates put aside 25 per cent of their earnings, before taxes, to finance a center...