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Brass Tacks

By Daniel Ellsberg

No one knows all the answers about compulsory medical insurance. The American Medical Association, among others, has raised some of the questions: the eventual cost, the effect on quality of service, possible abuse by "frivolous" patients, and the added burden on doctors.

They also make some predictions, some more probable than others. Most of their arguments can equally well be used against voluntary insurance programs--and the AMA has so used them in the past. Nevertheless, a valid case against government insurance is certainly possible.

The question remains: What should we do to improve medical care for the mass of the people? The AMA is committed to opposing any new federal health legislation whatsoever--including Republican bills for aid to voluntary associations. At the same time, the Association has reported that only 20 percent of the public can meet the cost even of minor illnesses without outside help. For the other four-fifths, the doctors assert, present organizations for voluntary insurance are sufficient.

The AMA speaks of "full-coverage hospital, medical, and surgical insurance plans." No such plans exist. Most programs cover hospitalized illness, which is only half of national medical fees. Almost none of the AMA-approved plans provides for preventive medicine or covers chronic diseases, such as heart disease, arthritis, and diabetes, which claim 26 million victims.

Government figures for those whose insurance "approaches adequate coverage" is 3,500,000, or 2 percent of the population. Although one-third of the population has some health insurance, voluntary plans pay only one-tenth of the national medical bill.

The very groups that most need medical care cannot afford insurance any more than they can afford doctors. Southern and western states, with 43 percent of the population and the lowest standards of medical care, have only 17 percent of the membership in voluntary insurance groups. No AMA proposal provides for the two-thirds of the population who are not now covered by health insurance in any form. Why then is the AMA offering voluntary insurance as "the American answer to every question of medical service, care, and cost"?

Raymond Rich, who resigned as AMA's public relations counsel in 1947 because the organization had become identified "with the economic interest of the doctors," delivered the indictment. "The association has yet to take unequivocal action . . . to seek the truth on the economic and social aspects of medicine, to put the public first, and to become adequate to its responsibilities."

Dr. James Howard Means, professor at Harvard Medical School and chief of medical services at Massachusetts General Hospital, is more specific. "Organized medicine cries now for voluntary health plans but does little to produce them. The record shows that when others have sought to do these things, organized medicine has obstructed them. A learned profession has sunk, or been dragged, in its political sphere, to a distressingly low level."

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