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Labor Action, 7 November 1949

 

Kate Leonard

AMA’s Campaign Against ‘Compulsory’
Health Program Reeks of Hypocrisy

 

From Labor Action, Vol. 13 No. 45, 7 November 1949, p. 4.
Transcribed & marked up by Einde O’Callaghan for ETOL.

 

The reactionary American Medical Association has organized medical hypocrisy in the cause of income.

The AMA represents itself as making a sort of Custer’s Last Stand for medicine, a free society and. civilization. Reduced to its common denominator its reprehensible campaign means “Don’t interfere with our revenue,” but it is carried on in the name of the advancement of science and in the name of devotion to the “people” and the patient. This is accompanied with broad innuendos that the government is ambitious to compound pills and write prescriptions.

The entrenched medical interest does not yet stand alone, but that it has been losing ground is clearly demonstrated by its retreat to advocacy of voluntary health insurance, which yesterday it met with all-out opposition; by the AMA’s attempts to monopolize the voluntary plans; and by the very frenzy of its opposition to the Truman health proposals which call for more complete coverage for the population.

The AMA would have us believe that the Truman health plan is both ‘‘compulsory’’ and “socialized” medicine. “You can’t have it both ways” would be a completely adequate answer to this cant, except for the simple truth that the Truman plan is neither compulsory nor socialized medicine.

This stupid and ridiculous charge is bolstered with slander against the British health service. (The British plan is more comprehensive than the Truman plan, but this does not make it socialized medicine. One of its achievements in the past year was to supply 8,359 artificial limbs and 7,226 artificial eyes, substitutes no doubt for 8,359 arms and legs amputated and 7,226 eyes gouged out in World War II and in industrial accidents. (Under socialism, doctors will lose this type of bulk practice.) This charge is meat only for men of the ilk of Dewey and Senator John J. McClellan, Arkansas Dixiecrat.

The AMA has been instructed by Senator Lister Hill that “mere attack on socialized medicine is not enough.” Perhaps because it realizes the impotence of this approach, the AMA does not put all its eggs in one basket.

The “compulsory” medicine charge is more insidious. It is linked to the retreat to the trenches of voluntary health insurance, the alternative now offered to national health insurance. The AMA proposes the extension of the voluntary plans under AMA control and has been working fast to solidify its position in the voluntary projects.

The AMA and 15 local societies are under investigation by the Department of Justice. These include 13 6tate and county medical societies affiliated with the AMA, one Blue Cross-Blue Shield plan and one Blue Shield plan. This list does not include three medical societies investigated earlier, against one of which there is a civil suit already instituted.

Attorney General McGrath has explained this intervention by the antitrust division of the Department of Justice by stating that this action follows “complaints from doctors and the general public charging the AMA and certain other medical associations with conspiring to restrain and monopolize the prepaid medical plans not conducted under their sponsorship and operated in competition with plans controlled by them.”
 

Regimentation Bogy

The AMA’s program is sloganized: “The voluntary way is the American way,” and by the same reasoning, the national health plan is “compulsory,” state medicine, and terribly un-American. Labeling the national health-insurance plan “government-control-led” medicine does more than insinuate that government officials are ambitious to practice medicine without a license: It harks back to the theory that “the best government is the one that governs least,” certainly a recurring if discredited theme in American political thought. It tries to spread the onus attached to regimentation in the public mind to a proposal to make medical care available to the people.

It is important to point out that the AMA does not call the national health plan “compulsory health insurance” because it fears medical regimentation for the patients, nor do they call it compulsory health insurance because the insurance features of the national plan call for financing by a payroll tax of 1½ per cent to be paid both by employers and workers; but because under the plan physicians would be paid by the government for services extended far beyond what it is possible to insure under any voluntary plan, and it thereby reduces the physician’s field for “private enterprise.”

If this does not too much concern the society doctor and the financially top-flight men, it really hurts those physicians who are doing better than quite well under the present system. This group is the backbone of the AMA’s opposition, the cadre in the $3,000,000 campaign. Industry has not protested loudly against the payrolldeduction proposal. The opposition comes from the AMA, politicians under their influence, and the “economy” boys who would cut the budget only at the point of social services, and who try to make this palatable with cliches like “we are for a state of welfare, but not for a welfare state.”

To criticize the plan because it would withhold a tax from the worker’s wage is criticism from the left, something the AMA could not dream of. They are currently wondering what is so offensive about a means test. The AMA is for contributory health insurance. “All” they ask is that it be limited and controlled by them.

The compulsory charge is hypocrisy twice compounded. Doctors are not, and never have been, opposed to compulsory medicine. It has been with us always, and doctors to a man recommend it, urge its extension, and participate in it at least from the day they pass their state board exams.

There is no way except by law in any organized community to handle such problems as epidemic, immunization, etc. It is perhaps worthwhile to point out that where vaccination is ordered by law, the doctors and not the city fathers designate the serum to be used. Sanitation measures and pure - food - and - drug acts fit nicely into the category of compulsory medicine. Public health measures are in essence compulsory medicine.

It is significant that one of the problems receiving wide attention from the medical profession at this time is the need to extend public health services not only to improve maternal and child health, or the care of the mentally ill, but into fields such as the chronic illnesses which are becoming more important because the population is becoming older, and because the fight to reduce and eradicate communicable disease has made progress.

The Truman health proposals are not compulsory medicine. The national health bill, in addition to the insurance feature, would grant federal subsidies for medical schools, for local health units, for hospital construction, and for rural doctors. It is a proposal to make medical care available to the people. If the health act becomes law and an operating plan, it would be possible not only to pay a doctor for his services and a hospital for its care, but it would make it possible to find a doctor and a hospital to go to—no mean consideration for large sections of the population and great areas of the country.

Of the babies born in South Caroline, 34.4 per cent are ushered into the world, not in a Fair Deal package, but by a midwife or a kind neighbor. The infant mortality rate in New Mexico in 1946 was 89.1 per 1,000 live births.. Mississippi has 1.8 hospital beds per 1,000 population, and one physician for every 1,784 persons.
 

Voluntarism Inadequate

It is known that the British people flocked to their service for badly needed medical care as soon as they saw a way to finance such care. During the first year, 41,200,000 patients were treated by physicians; 8,500,000 persons had their teeth fixed; 8,359 , artificial limbs, 7,226 artificial eyes, 21,345 surgical boots were supplied, not to mention the much calumniated spectacles. There is a comparable need in the U.S. and the same response could be expected. However, it would be correct to welcome more “regimentation” in the field of health than is provided for in a plan to make “available” competent medical care. Health “regimentation” of this sort is something we are apt to get too little of. The real regimenters have a penchant for other types.

The AMA’s inadequate alternative to national health insurance has been contrasted frequently and in great detail to the national health act. The federal health plan calls for complete medical service by a family physician of the patient’s choice, specialist service, hospital care, laboratory and X-ray service, unusually expensive medicines and appliances, to be financed by payroll taxes.

The case against the voluntary plans has been stated as follows by Dr. Ernest P. Boas, chairman of the Physicians Forum (1) They do not offer comprehensive coverage. (2) The cost of comprehensive coverage under voluntary plans would be prohibitive for people in the lower-income groups and many in the higher-income brackets. (3) The plans would be unable to fulfill their functions in times of unemployment. (4) In those voluntary plans which operate with large panels of physicians compensated by the fee-for-service method there is lack of control of the quality of care provided. (5) Government subsidy to voluntary plans for care of the indigent or the medically indigent would result in widespread application of the means test.

As recently as October 26, Margaret Klem of the U.S. Public Health Service estimated that in 1947 less than 10 per cent of the total family expenditures for medical care were covered through voluntary health insurance for those families carrying such insurance, since these plans tend to concentrate on alleviating the burden of surgical-hospitalized illness. This is how these two alternatives shape up.

Health insurance is today a political football, with the AMA responsible for bringing its own kind of dirty politics into this picture. National health insurance offers a workable solution at the present time for meeting people’s need for medical care.

 
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