The Big Debate

The big medical question before the U.S. last week could be stated like this:

Do the medical provisions of the Wagner-Murray-Dingell bill* for the extension of social security--$1.8 to $2.7 billion a year to be spent on group medical care for some 110,000,000 U.S. citizens--make good sense?

The arguments of the opposition (principally the conservative American Medical Association): 1) the bill is a threat to freedom because it might restrict a patient's free choice of physicians; 2) it might cut the doctor's income by putting an end to fee-for-service; 3) it might lower the standards of medical care; 4) it would probably put control of U.S. medicine in the hands of lay bureaucrats; 5) anyone in the U.S. needing medical care can get it right now (free, if necessary), if he will go to the trouble of asking for it.

The rebuttal (chiefly by organized labor and reformers in & out of Government): 1) the poor do not have a free choice of physician now, and the bill proposes to give everyone this privilege; 2) doctors would make as much as they do now and those who wanted to keep on with private practice could do so; 3) standards of medical care would probably be raised--by giving physicians better access to expert consultation, modern equipment and technical help than individual practice ever could; 4) the bill's present administrative provisions are only suggestions; 5) there are parts of the U.S. where the needy cannot now ask for and get adequate medical care, because there are no hospitals, no specialists.

Public Opinion. By & large, the average citizen has been content to let the doctors and the reformers think and argue it out. His own attitude on state medicine is still fuzzy.* But according to two recent surveys, it is beginning to crystallize.

A survey by the Opinion Research Corp. found that only 37% favored a "Federal Government Plan" for health security (20% answered "Don't know"). Another survey by the National Opinion Research Center found that 68% favor a broadened social-security law covering payments for doctor and hospital care. (The NORC blames the apparent discrepancy in the surveys on the way the ORC worded its questions: people tend to say No when confronted by phrases like "Federal Government"). Strongly implied in both surveys was public impatience with present distribution of medical care, alarm at its cost and a feeling that something should be done.

If this feeling suggests a trend, however gradual, a survey of the doctors in the armed forces (one-third of all active doctors) tends to confirm it: 53% of them would like to go into group practice after the war.

Inching Along. The stolid American Medical Association, although still unconvinced, has finally given up its golden dream of preserving the status quo. It has even managed to swallow two pills: 1) some forms of group practice (like the Mayo Clinic), 2) voluntary group medical insurance (such as many big corporations now sponsor for their employes). But the A.M.A. has always opposed a combination of the two, in which the insured group hires a group of doctors to take care of its members.

Last week, with the Wagner-Murray-Dingell bill dangling overhead, the A.M.A. showed signs of yielding another inch. At Manhattan's Waldorf-Astoria, 234 representatives of the A.M.A.-minded National Physicians' Committee, plus various industrialists and actuaries, met to figure out means to forestall Government-controlled compulsory medical insurance. A.M.A. Journal Editor Morris Fishbein, longtime chief opponent of group medicine, said frankly that unless organized medicine provides some good alternative, the Government will take over. He even went so far as to think it "well within the desire and ability of American medicine to develop for the American worker plans . . . which will be democratic."

Despite this hopeful approach, the net accomplishment of the meeting was nothing more than approval of voluntary group medical insurance--one short step beyond individual insurance. This spurt in A.M.A. thinking, according to some critical observers, brought the organization up to 20 years behind the times.

* This bill, long dormant in Congressional committee, is the U.S. counterpart of Britain's Beveridge Plan. By increasing the social security tax to 12% of salaries up to $3,000 (half to be paid by employers, half by employes), the bill would provide old-age, unemployment and disability insurance for most U.S. citizens--besides allocating about one-fourth of the total raised to a comprehensive program of medical care, hospital expansion, medical education and research directed by the Surgeon General of the Public Health Service. * The old familiar term "socialized medicine" has been generally discarded as too loose and covering too many different types of medical insurance.

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