MEDICINE'S DUAL SOCIETY

...and the auxiliary and ancillary personnel, predominantly female and working-class by definition, at the bottom and supportive to all...

...As Vicente Navarro has observed, the health-care sector reflects the general society: "The division of roles found in the family also appears in the health sector, with the predominantly upper class, white male physicians being, according to conventional wisdom, the unquestioned leaders of the health team...

...a huge base at the bottom supports a thin column of elite professionals, and there is an enormous disparity in income distribution among the occupational categories in health care...

...In 1973, 20 per cent of all physicians practicing in the United States were foreign-trained, and foreign-trained physicians represent about half of the new physicians added to the net U.S...

...It shows that a service sector dominated by a professional elite in control of high technology does not necessarily mean that services will be adequately produced or equitably distributed, and that service-sector employment does not necessarily provide "fulfilling" jobs and sufficient income...

...There are twice as many surgeons as general practitioners, and, in fact, the number of general practitioners per 100,000 population actually decreased from 1963 to 1971...

...But women accounted for 70 per cent of all medical technologists, 97 per cent of all registered nurses, 94 per cent of all medical clerical positions, and 83 per cent of all medical non-clerical labor jobs...

...This gap has been widening — especially since 1967, when Medicare began to pump millions of additional dollars into the health care system without imposing any controls on physicians' fees...

...Physicians and other health-care resources are drawn to those sectors where the money is most plentiful, the climate most pleasant, and the social amenities most abundant — and that is obviously not where the need is greatest...

...Data from the National Center for Health Statistics (NCHS) reveal, for example, that between 1969 and 1973 age-adjusted death rates due to all causes were about 25 per cent higher for non-whites than for whites...

...The 1969 median income of the 2.3 million workers at the lowest level was only about $4,000, and the average health technician or registered nurse earned less than $6,000...

...Nonetheless, those who would benefit most from basic health-care services are least likely to receive them...

...the nurses and paraprofessionals, predominantly female, the dependents and appendages to the physicians...

...New York City does have one physician for every 360 residents — but in the poverty-ridden South Bronx, the ratio is one to 10,000...

...The two-class structure of the health care system refutes the romantic notion of the vaunted service sector of the "coming post-industrial society...

...Physicians, who make up only 7.3 per cent of the health care workforce, have more income — $12 billion in 1970 — than the 2.3 million workers who make up the bottom 54 per cent of health-care workers...

...In 1969, the median income for physicians was $40,550, placing them in the top 1 per cent of all Americans...

...Less clearly recognized is the division within the economic structure of the health care industry itself: It includes a few hundred thousand physicians who enjoy extraordinary wealth, status, and political power, and 4.5 million workers who have, for the most part, substandard wages, little job security, and no prospect of upward mobility...

...higher in lower-income groups than among the well-to-do...

...The suburbs average one physician to 500 residents...

...Not surprisingly, these are the poor who are ineligible for Medicaid, the unemployed, transiently employed, low-wage employed, those employed in low-income industries, and those who have high health risks — the very people who often require the most health care and receive the least...

...Furthermore, physicians tend to specialize in the most lucrative and least troublesome sorts of practice...

...By 1974, the average income of physicians had climbed to $51,000, compared to an average family income of $13,000 for all Americans...

...Other studies reveal similar correlations between income levels and incidence of major diseases...

...According to the Forward Plan for Health, 1977-81, issued by the Department of Health, Education and Welfare, "About thirty million people under the age of sixty-five simply do not have either private health insurance or public assistance in meeting the costs of health care...

...But the system could not function without its 140,000 therapists, 340,000 technicians, 720,000 registered nurses, 340,000 clerical workers, and almost 2,000,000 non-clerical workers...

...in the cities, the ratio is one to 2,000...

...The critical shortage of primary-care physicians means that those who cannot pay a premium price must seek primary care in overcrowded, impersonal emergency rooms and clinics...

...A survey of various socioeconomic groups in Baltimore between 1960 and 1973 found higher mortality in working-class communities than in upper-class communities, and the difference increased over the thirteen-year period...

...Even when covered by public or private health insurance, the poor have less access to quality care...

...Similarly, fewer than 3 per cent of all physicians were black in 1970, but 30 per cent of all clerical and non-clerical medical workers were black...

...A 1969 NCHS survey found that work loss, restricted activity, and disability due to illness were uniformly Martin Brown, an economist, is associate editor of Pacific News Service...

...health manpower pool each year since 1963...

...People tend to think of the healthcare system in terms of its 300,000 physicians, 270,000 dentists, pharmacists, and other practitioners, and 150,000 administrators and scientists...

...Medicine's dual society A two-class structure of health care mirrors the outer world Martin Brown Health care in the United States — a $200 billion-a-year industry that accounts for almost 10 per cent of the Gross National Product — offers a microcosm of a society increasingly divided into two worlds...

...Many studies confirm the relationship between income and health status...

...Medicare and Medicaid have left intact our two-track system of medical care...

...The division in health-care delivery has long been recognized and documented: The poor, with the greatest need for health services, have the least access...

...In that system, there is almost no "middle class...

...Women hold a minority position in the upper reaches of the system — in 1970, only 6.9 per cent of all physicians were women...

...Finally, class stratification operates even within the medical profession itself...