Medical and Hospital Insurance Problems

Abstract

Doctors who discuss subjects like the one assigned to me must be careful not to use the words “socialism” or “socialistic” as epithets. If by the philosophy of socialism we mean that the strong should help to bear the burdens of the weak, doctors are the oldest and almost the only real socialists. Since the dawn of civilization, long before Karl Marx expounded his doctrines, they have adjusted their fees to the ability of their patients to pay in an effort to see that the rich shall meet the expense of supplying medical service to the poor. As a class, they believe in the general principles of insurance, that thrift is a virtue, and that the wise will budget against heavy unforeseen expenditures. I have asked many of my own colleagues how they would like to have their county medical society practice as a guild, receiving two dollars per month for each man, woman, and child in the county, this money being distributed according to the ability, energy, and popularity of the members. The great majority of those questioned appeared to believe that under an ideal administration of such a plan, with overhead expense cut to a minimum, with no duplication of equipment or labor, and with the time-consuming amenities incidental to competitive private practice abolished, they would find their incomes greater, their work easier, their responsibilities lighter, and their leisure time longer. Doctors do not object to having their fees paid. They support workmen's compensation laws in the various states in spite of the fact that these laws provide professional services under a compulsory insurance plan. Why, then, do doctors invariably view with suspicion any proposal to supply medical services through such agencies as the Blue Cross, voluntary medical insurance plans, or compulsory insurance plansas proposed in the Wagner-Murray-Dingell bill. I think the answer is simple. It is not because these proposals are socialistic. What is feared is not socialization but regimentation. We fear, and we have good reason to fear, the introduction of a third party between ourselves and our patients. This third party would have the power, because he would hold the purse-strings, to say what patients should be treated, how long, and in what manner, though his only qualification for his job might be that he is a good, faithful wheel horse of his party. We have reason to fear regimentation because of our experience with the care of the indigent sick during the depression. When social workers or overseers of the poor had to contend not only with social problems, but also those which could be solved only by professionals, the whole administration of medical relief was unsatisfactory to everyone concerned. Some progress in efficiency, economy, and the promotion of the welfare of the patients began to be made only when social and medical problems were completely divorced, the former being solved by trained social workers, the latter by medical men.