Battle Ahead

There would almost certainly be a showdown fight in 1949 on just how far the U.S. would move toward some sort of socialized medicine.

In Chicago last week, Blue Cross Health Service, Inc. (which offers prepaid hospitalization on a distinctly non-socialistic plan) was incorporated. The nonprofit stock insurance company (capital: $500,000) proposes to smooth out the differences between local Blue Cross plans, so that a big company can guarantee its employees the same protection no matter where they live. For instance, if a company's national contract calls for 30 days' hospitalization, and the local plan for only' 21, the insurance company would pay for the extra nine days. Blue Shield (for doctors' bills) can join up later if the American Medical Association withdraws its opposition (TIME, Dec. 13).

In the past four years, Blue Cross has lost 4,000,000 members, chiefly to commercial insurance companies, because it could not give nationwide coverage. Now that it can, Dr. Paul R. Hawley, onetime medical director of the VA and now executive of Blue Cross-Blue Shield, predicted a jump of 8,000,000 members in the next 18 months, to bring enrollment to 51 million. Was he afraid of the insurance companies? "Sure, they'll try to undersell us. But we aren't mad. Hell, they've made us go back into competition. The field is big enough for everybody."

The U.S. Government saw the big field too. In Washington, Federal Security Administrator Oscar R. Ewing and his planners were polishing up a compulsory national health insurance bill for this month's session of Congress. Probable result: a bill along the lines of Ewing's ten-year health plan (TIME, Sept. 13). Payroll deductions would eventually take between 3% and 4% of incomes up to $4,800, paid half by the employer, half by the employee. Still undecided: whether doctors would be paid by the case, or, as in Britain, according to the number of patients.

The A.M.A. is dead set against any sort of national hospital-medical insurance plan, even a voluntary one. The A.M.A. cannot see it as a step to forestall socialization. In last week's A.M.A. Journal, Editor Dr. Morris Fishbein thundered against Government-in-medicine: "At the same time that many of our political leaders oppose communism they move toward communism by embracing socialism."

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People who oppose any more government in medicine got new ammunition this week. Almost a year ago a "task force" of the Hoover Commission began a survey of medical services run by the government. A summary of the report, made public this week, did not argue the question of compulsory national health insurance, but it pointed to waste, duplication, extravagance and lack of planning.

The government has taken on responsibility for the medical care, in some degree, of 24 million people (one-sixth of the population), but the task force found there was almost no sense-making cooperation between government medical-care agencies --the armed services, the VA and the U.S. Public Health Service.

The present organization, said the report, is "impotent" in the proper use of medical manpower and hospital beds available. In New Orleans there are five federal hospitals, with a capacity of 1,620 beds, and only 913 patients; in New York City, there are eleven federal hospitals with a capacity of 8,257 beds, only 5,330 patients. Yet federal agencies are planning to build still more hospitals.

What to do about it? As a first step, the task force recommended closing many small hospitals run by the armed services. Patients would be sent to other federal hospitals or to community hospitals. The government, said the report, should spend more money in helping community hospitals, rather than building competing ones. For the long run, the task force suggested that a new cabinet department, to include a National Bureau of Health, might make some sense of the government's mixed-up, bogged-down health, education and welfare programs.

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