Medicine: Reform from Without?

As the spokesman for organized medicine, the A.M.A. holds that changes on the medical scene should be made by doctors, and laymen had best keep hands off. This week a vigorous dissent comes from a ruggedly individualistic Yankee doctor with a brilliant record of medical achievement. Says Boston’s Dr. James Howard Means* in Doctors, People, and Government (Little, Brown; $3.50): “The impulse to reform in medical public affairs comes usually from without, and resistance to it from within the majority fold of organized medicine … It is only under the lash of public opinion that organized medicine makes any social progress.”

Is there need for change? Emphatically yes, says Dr. Means. Though U.S. medicine is often touted as the best in the world, he asks, “Best for whom? Doctors, patients, or everybody? Certainly it is not best for everybody, else the public affairs of medicine would not have been in turmoil for the past two decades.”

Dr. Means insists that he is as much opposed to socialized medicine as is the A.M.A. itself (from which he resigned in protest against its assessments to finance lobbying and pressagentry against the Truman national health plan). But, he believes, the danger that government may take over all medicine increases the longer a nation waits for a solution to the problem of making the best medical care available to all its citizens, and finding ways for them to pay for it. Dr. Means holds that the clearest threat of socialized medicine in the U.S. lies in “the colossal medical activities” of the Veterans Administration. “If we have anything that amounts to socialized medicine,” he writes, “the veterans’ medical services are it! … It would be an ironic turn of fate if the U.S. should find itself in the same situation [as Britain] by default—by unwittingly letting the V.A. empire take over!”

What to do? First, the Federal Government must put its chaotic medical house in order by adopting the consolidation plans of the commission headed by ex-President Hoover (which ex-President Truman also supported). At the same time, voluntary agencies seeking to improve the nation’s health must organize effectively in a nationwide council. Dr. Means makes these recommendations:

¶ Medical care should be prepaid on an insurance basis—”payment … on a fee-for-service-as-rendered basis is outmoded.”

¶ Doctors should practice in groups and be paid straight salaries, or salaries plus a share of group earnings.

¶ The Federal Government should make grants-in-aid to local bodies, which would have to match these grants in setting up improved medical facilities.

¶ Each university hospital should become the center of a web of medical facilities, including a prepayment plan, a home-care plan and group practice, and should also serve smaller, satellite hospitals in a big-brother capacity.

-For 36 years on the medical faculty at Harvard, 28 years chief of the medical services at Massachusetts General Hospital. Now, in “retirement,” on the medical staff at M.I.T.