American Medicine Tomorrow

Abstract

In his excellent book comparing the theories of Oswald Spengler and Raymond Pearl, Today and Destiny, Edwin F. Dakin expresses a truism that is of particular significance for doctors in these dynamic times: “Any concept—economic, political, or cultural—which leaves its possessor wholly unprepared for tomorrow is of doubtful validity. Conversely, men who are not surprised when the future comes, lie very close to the truth.” President Lowell S. Goin was pleading for a true concept of the future when, in a recent letter to Members and Fellows of the American College of Radiology, he warned of impending social changes that would almost certainly result in new methods of distribution for medical services. He urged radiologists to actively encourage voluntary prepayment plans for medical care, sponsored by medical societies, as the soundest and most desirable method among the many that have been proposed. At the same time, he warned that some form of socialized medicine, embodying compulsory health insurance, is not an inconceivable eventuality. Doctor Goin's concern would seem to be justified by what most observers have recognized as an increasing pressure of public opinion. The attitude of the public was succinctly expressed by Fortune magazine in its December issue: “The state of medicine in the United States is a social problem because the country's conscience has made it so … people who cannot find or pay for proper medical care are resentful.” I have been sharply criticized in some quarters for a statement made in my Annual Report to the Board of Chancellors two years ago, in which I referred to the powerful social forces at work throughout the world and their manifestation in agitation for socialized medicine in this country. I remarked that there was a growing conviction among medical men that a head-on opposition to this unmistakable trend would be as unwise as it would be futile. Subsequent events have proved, I believe, that the demands for improvements in the distribution of medical services must be met, either by voluntary plans for prepayment or, if not, then by compulsory health insurance. It seems unnecessary to recite the extensive evidence that this is so. A half dozen public opinion surveys have revealed a definite public demand for insurance against medical costs. Brigadier General Fred W. Rankin, in his presidential address before the American Medical Association House of Delegates last year, called upon the medical profession to recognize the gathering momentum of trends that are “directed toward some form of national health service as an integral function of the state.” He made a plea that they be regarded not in the light of apostasy, but rather in the light of realism. Dr. Alan Gregg, whose words carry considerable weight in the medical world, has uttered a similar warning. “The danger for medicine in America lies in failure to acknowledge and to study the sociologic aspects of medicine—the social matrix.