Medicine: The Crisis in Health Care

Medical care in the U.S. is more a collection of bits and pieces with overlapping duplication, great gaps, high costs and wasted effort than an integrated system in which needs and efforts are closely related. —Health Manpower Commission, 1967

That somber conclusion is shared by the Senate Subcommittee on Executive Reorganization, which has spent the past two years assessing the state of medical care in the U.S. Under the direction of Chairman Abraham Ribicoff, the subcommittee listened to scores of doctors, hospital administrators and Government bureaucrats. Their testimony adds up to a dismal tale of extravagant inefficiency, of reliance on slogans rather than thoughtful, effective solutions to the pressing health problems of the nation. As a result, although the U.S. is the richest country in the world, it ranks 18th in infant mortality and 22nd in longevity.

Family Doctor. Such statistics strongly suggest that the system of private health care is on the verge of crisis. In a 500-page report to be released next month, the subcommittee notes that one reason the poor receive improper care —or none at all—is simply the growing shortage of doctors. According to the report, to provide all the physicians needed (an estimated 600,000) would cost the U.S. $1.2 billion a year until 1985. Meantime, the country has become dependent on an influx of foreign doctors, who account for 20% of the new physicians licensed every year.

The symptoms of the health-care shortage are ever more obvious. For the affluent it becomes harder to get an immediate appointment to see a doctor for anything short of an emergency. For the poor, the hospital emergency room has become a kind of “family doctor.” Yet the Federal Government has spent enormous sums on health care. With passage of the Comprehensive Health Planning and Services Act in 1966, federal spending has soared from $5.9 billion to $16.6 billion in fiscal 1969, and the direction is ever upwards.

The fault, according to the subcommittee, is the lack of a national health policy to provide form and direction to federal health programs. Under the current setup, even HEW’s Dr. Roger O. Egeberg, the nation’s top health officer, has effective control over only 22% of his department’s budget. To consolidate health programs, the subcommittee has called for a council of health advisers similar to the agencies now dealing with economic and environmental matters.

Empty Beds. Competition between different departments and agencies of Government makes for enormous waste, says the Ribicoff report. In Vallejo, Calif., for example, one hospital received a $607,000 grant under the Hill-Burton hospital-construction program. Meantime, another hospital received a $380,000 loan from the Small Business Administration to expand its facilities. The result: so many beds that half of them are usually empty. In San Francisco, interservice rivalry between the Army and the Navy resulted in the construction of separate hospitals. The cost to the taxpayer was an extra $10 million in building costs and $8.2 million each year in operating expense.

More than anything, the report emphasizes the need for a review of the whole system as a prelude to a fresh approach to public health. Too often in the past, the federal remedy for any ill has been to appropriate more money. That cure is no longer effective. As Dr. James A. Shannon, former director of the National Institutes of Health, told the subcommittee: “It is clear that a simple extension of present activities, coupled with further patchwork approaches to critical needs now apparent, will provide no long-term solution.”