Frontier on Health

...In view of the fact that competitive individualism and a completely open market have long ago ceased to exist in medicine, the authors say, "the issue of 'freedom' versus 'controls' is largely academic...

...Both bring to the task years of study and experience in social security, industrial relations, and related fields, and their writing is well above par for the products of academic scholarship...

...They point out that the imbalance in the existing pattern of insurance coverage and other inflationary forces are tending to depreciate the level of protection against the costs of illness and warn that some degree of government intervention is inevitable to control costs and provide coverage for such poor-risk categories as the aged...

...They see the issue instead as "whether the many existing controls can be coordinated and redirected toward greater emphasis on economy while . . . providing the maximum degree of freedom compatible with the maintenance of quality...

...They deplore "futile attempts to perpetuate . . . a past which, for the great majority of sick people, never existed" and call for a shift "from an authoritarian to an educational relationship and from the passive to the responsible patient...

...Another way of defining the issue, they state, is that it "may no longer be regulation versus laissez-faire but regulation versus public operation...

...Brilliantly—and devastatingly—examined are the medical profession's "tarnished image" in the popular mind and the mythology of the doctorpatient relationship to which organized medicine continues to cling, even though it has become totally irrelevant under the impact of scientific advances...

...A complete government takeover may become inevitable if the doctors fail to adapt themselves and their institutions to the imperatives of progress...

...The Somers feel that the traditional concept of the doctorpatient relationship has degenerated into a public relations stereotype, "has lost most of its beneficent value and may now have become injurious to doctor and patient alike...

...Reviewed by Selig Greenberg T ^ H I S BOOK by a husband-and-wife •"- team of Haverford College economists is a truly remarkable achievement...

...the subtle ingredients and changing nature of the doctor-patient relationship, and many other factors certain to have a bearing upon the future organization of medical care in this country...

...They are not at all sure, however, that these goals can be achieved at a practical price solely under voluntary auspices...

...Skillfully analyzed are the transformation of medical practice, the modern hospital, and the drug industry...

...Starting with a vivid description of the growing complexity and changing character and structure of our medical services, the authors examine provocatively the varied phases of the challenge of rising costs and expectations in the health field...

...The authors rightly hold that the primary concentration of health insurance upon surgery and other hospitalized illness is economically, as well as medically, unsound and that there is an urgent need for extending coverage to out-of-hospital services, including doctors' fees and drug and dental costs...

...In an area long beset by sloganeering and extreme partisanship, Herman and Anne Somers have, a fortunate knack for puncturing cliches gently and advancing revolutionary ideas in a tone of moderation...

...the causes of spiraling medical costs and the crisis confronting voluntary health insurance...

...The book's only drawback— and it is more than anything else the penalty of excellence—is that its sheer bulk and profusion of detail may deprive it of the wide readership it richly deserves...

...It is primarily up to the medical profession's maturity and sense of responsibility, they conclude, whether the high expectations of the American people for continued improvements in health care can be met through a combination of private and public arrangements within our pluralistic tradition...

...Exhaustive in scope, balanced in approach, and illuminating in its insights, it is by far the best job yet done on the manifold aspects of the complex problem of the organization and financing of medical care in the United States...

...the farreaching alterations in the volume and character of consumer demand for medical care...

...Such a shift and an organizational structure conducive to quality as well as economy entail, they emphasize, new institutional arrangements, notably those of group practice...