BAD MEDICINESocialist Medical Care Is Bad Medical Care

by

Gar y Allen

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This art icle first ap peared in AM ERICAN OPINIONmagazin e, a Co nse rvative journal of opinion, in Fe brua ry of1971. T he subsc rip tio n rate to AME RICAN OPINIO N is tendollars per year, to an y address in the Uni ted St ates; twelvedollars to o the r co untries . For eithe r reprints or subscriptionsaddress :

AMERICAN OPINIONBelmont , Massachuse tts 021 78

BAD MEDICINESocialist Medical Care Is Bad Medical Care

Gary Allen, a graduate of Stanford Uni­versity and one of the nation 's topauthorities on civil turmoil and the NewLeft, is author of Communist RevolutionIn The Str eets - a highly praised anddefinitive volume on revolutionary tacticsand strategies, published by WesternIslands. Mr. Allen, a former instructor ofboth history and English, is active inanti-Communist and other humanitariancauses. Now a film writer, author, andjournalist, he is a Contributing Editorto AM ERI CAN OPINION. Gary Allen isalso nationally celebrated as a lecturer.

• ONE cannot venture from one's bedthese days without being bump ed by atrial balloon pleading the necessity ofcompulsory National Health Insurance,the current balloonist euph emism forsocialized medicine. Such trial balloon spop out of your television set, float upfrom you r morning newspaper, or burstfull-blown from between the pages of theslick magazines. They contain hot air andan eme tic called politicus promissorus.And they could defin itely prove dan­gerous to yo ur health .

One of the first trial balloons to comewafting along in this rejuvenat ed oldcampaign was launched by Nelson Rocke­feller from the National Governor's Con­ferenc e in September of 1969. Persuadedby Rockefeller , the governors formallypassed a resolution suppo rting com­pulsory Nation al Health Insurance. Fro mthere, the clown s of the EstablishmentPress grabbed the ropes, threw ou t thesandbags, and began honking and howlingthat "America has low quality med icine,"and " doctors are responsible fo r rising

FEBRUA R Y, 1971

costs," and "America ranks 13th in infantmortality ," and that " we have a nati onalhealth care crisis."

In the spring of last year the ColumbiaBroadcasting System telecast a produc­tion titled " Don' t Get Sick In America"which should have won the Joseph PaulGoebbels Award for 1970. The manwielding the meat axe for C.B.S. wasDaniel Schorr. After gouging America'sdoctors in one of the bloodiest perfor­mances on record , Schorr actu ally de­clared that "other Western nations havelong since solved [their] problem withnational health systems ." Given thefailure of Ameri can medical care , dead­panned Daniel Schorr , "it may be th atthe organization of medicine is too im­portant to leave to doctor s." He main­tained tha t th e same bureau crats and poli­ticians who have given us galloping infla­tion, federalized educat ion , no-win wars ,and subsidized indolence will now lead usto the promised land of guaran teed he alth.

Besides the expected salvos in theEstablishment's slicks, broadsides haveemana ted from such un expected batteriesas Better Homes And Gardens, PopularMechanics, and other unlikely sources. Amajor campaign to nati onalize Americanmedicine has begun, and the Insiders whocall the shots for the Establishment haveordered up even the popguns. Typical ofthe bombardment is this blast from SylviaPorter , th e nationally syndica ted "Lib­eral" economist , in a newspaper columnshe called "S ocialized Medicine ForecastAs Cost s Soar " :

Indisputably and irreversibly onthe way in the U. S. is a national

health insurance system - whichwill provide all of us - rich or poor,old or y oung, white or black - withcomprehensive or near-comprehen­sive coverage of our health costs. Inone fo rm or another, "socializedmedicine" will get the highest prior­ity in the next, 92nd, Congress.

The Los A ngeles Times fo r December8, 1970, put the point in the same vein,wriggled th e needle, and drew blood :

Before the next presidential elec­tion , Congress probably will enactsome kind of national health insur­ance fo r most Americans, financedby an increase in Social Securitytaxes. That was the signif icance ofthe 13-2 vote Monday by which theSenate Finance Committee ap­proved a plan that would insure al­most all Americans under 65 againstcatastrophic medical costs.

The legislat! m will not getthrough this Congress. But it is apreview of things to come in thenew Congress that will convene inJanuary.

The plan is similar in concept toone which Nixon Administrationofficia ls have been drafting for pos­sible inclusion in a special messageon health that the President plansto send to Congress early nex t year.

When the roll was called, how­ever, committee conservatives andliberals went on record in supportof the legislation. Democratsvoted for it 8 to 1 and Repub­licans 5 to 1.

Already five separate plans fo r social­ized medicine have been suggested. Themost staggering is Sen ator Edward M. Ken­ned y' s proposal for complete womb-to ­tomb "free" medical care , which carriesan estim ated cost of sco res of billions ayear. It is already obvious th at a majo r is­sue of th e 1972 presidenti al camp aign will

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be Teddy Kennedy's "ex travagan t" social­ized medic ine vs. Richa rd Nixon 's "hu­man e, but prudent" socializ ed medicine .Of course the word socialism will notactually be used by eith er camp. It offe ndsthe in telligent. But the Kennedy proposalwill p rovide the Nixon Administrationwith th e excuse it needs to put fo rth itsown "eco nomy " program for medicalMarxism. The spade work for th e plot hasalready been do ne in the White HouseR eport On Health Care Needs, releasedJuly 10, 1969 . It reads in part :

This nation is faced with a break­down in the delivery of health careunless imm ediate concerned actionis taken by Government . . . .

Our overtaxed health resourcesare being wastefully utilized.

Our incentive sy stems all lead tooveruse of high-cost, acute-carefacilities.

Our task now as a nation is toacknowledge the ex treme urgencyof the situation, to take certainsteps . . . .

Too of ten the government hasoperated independently , and evenblindly . . . . Medicaid was launchedwithout adequate preparation . . . .This administration is committed tocorrecting these past failures ofgovernmen t and to . . . begin theprocess of revolutionary change inmedical care sy stems.

So the seeds were planted. The Chris­tian Science Monitor, a national spokes­man fo r the Easte rn " Liberal" Estab lish­ment second only to the Ne w YorkTimes, announced th e beginning of th eharvest on November 23, 1970:

The White House is putting to­gether a massive national healthinsurance program that may wellcost taxpay ers in the neighborhoodof $5 billion to $8 billion a year.Although the plan is still in the

AMER ICAN OPINION

formulative stage, there is evelYevidence now that it will be readyfo r presentation to Congress in the1971 session. "It definitely will bethe principal part 0/ our domesticprogram next year," a Wh ite Housesource discloses.

A lthough 110 fi nal decision hasbeen made on how the plan willwork, some within th e administra­tion are leaning toward a methodby which the government's pay­m ents for health care would be all agraduated basis - paying all oralmost all 0/ the bill f or poorpeople and payin g a diminishingpercentage of the bill as peoplemove into higher incom e brackets.The plan would be on a voluntarybasis. But it would be expected thatalmost every body would find itcheaper than private health insur­ance and, thus, financially in theirbest interest to participate.

Why this R epublican administra­tion move in this direction ? Thereare already proposalsalong this linein Congress. Sen. Edward M. Ken­nedy 's plan, which has received th emost attention, would cost the pub­lic, according to som e estimates,f rom $50 billion to $70 billion ayear.

What the White House plannershave concluded is that , with thesoaring cost 0/ Medicare, there isnow no alternative available tosom e variety 0/ national healthinsuranee.

Was this largely a political moveon the part 0/ the administra tion - aresponse, for example, to the Ken­nedy proposal?Perhaps. But this re­porter [Godfrey Sperling Jr.] founda specific denial to this/rom a WhiteHouse staffer who said: "We havebeen looking into this for more thana year. The Democrats fo und outwhat we were doing and came upwith their own legislation. "

FEBRUARY. 1971

Few things are more important toAmericans than medical care. The fieldhas th us become a bon anza for everypolitical Barnum to com e dow n th e pik e.And , becau se the na tion has legit ima tehealth probl ems , th eir nostrums are beingbought by th e same peo ple who alwaysbuy " miracle cures" made of alcohol andsassafras, and sold by an ersatz W.C. Fieldscalling him self an expert. ColumnistJames Jackson Kilpatrick, who opposesNat iona l Health Insurance, commen ts onthe att raction of socia lized medicine:

On the sur/a ce, at least, the ideahas great political appeal. In recentyears almost every American familyhas experienced the pit-of-the­stomach impact of a stunning hos­pital bill. Som e urban hosp italsalready are charging as much as$100 a day for a room. Costs aresoaring every where.

And it is not only the high cost0/ m edical care. A powerful politi­cal appeal lies in the new egalitari­anism that seeps across our landlike morning fog. 1/ all men arecreated equal, it is asked, whyshould the rich man have betterdoctors than th e poor man ? To th econcep ts of equal opportunity andequal justice, it is urged, let usdemand equal appendectomies also.

W.C. Fields migh t have commentedthat we are being prepared for a lovelyfuneral. First we were to ld that all weneeded was government medi cal care forthe aged. After all, you can 't have oldpeople moaning about the house with themiseries . So we got Medicare. Then it wasnecessary to have care for the "poor" aswell as the aged. So we got Medicaid.When he was Secretary of Health , Educa­tion and Welfare, Robert Finch stre ssedthe necessity for en suring the medicalneeds of the young as well. So a Kiddie­care package is already in the federalperambulator. Th e idea is th at with the

3

middle -class taxpayer forced to meet thebill for medical care for the elderly, theindigent, and the young, he will soon bevulnerable to the line that "since you arepaying for it, you might as well get in onthe action!" It's the craziest come-onsince W.C. Fields got away with callinghimself Honest John because he oncereturned a man's glass eye.

Before America chokes on the "free"medicine bunkum, she had better checkthe fate of other nations which haveswallowed the stuff.

The National Health Service of GreatBritain is the premier example. JohnStrachey, the "former" Communist whowas Minister of Health when the N.H.S.was begun in 1948, confidently predictedthat such would be the str ides undersocialized medicine that the lives of theEnglish people might be "prolongedindefinitely."* Strachey had built hisreputation as a scholar on "proving" thatSocialism is "scientific." And no doubtsome of the Socialist faithful in Englandwere shocked when the new government"science" did not produce instant im­mortality for the average Englishman.

When Lord Beveridge planned Britain'sNational Health Service in 1944, he esti­mated the cost at about $500 million peryear. In the first year of operation the costwas double that. Now N.H.S. costs the tax­payers of England seven times what itspromoters claimed it would. Discountinginflation, the cost is still nearly three timesthe Beveridge estimate.

This has not been because of increased

*No, I don't doubt for a minute that Strachey ,a lo ngt im e pillar in the Fabian Socialist Society,was laughing up his sleeve at such boob-bait.Certainly John Strachey was no toe-prancingidealist. Zygmund Dobbs observes in hisscholarly Keynes A t Harvard that Strachey'sbooks were "required reading in the Commu­nist Party National Training School in NewYork City ."tEngland now spends on medical care only $77per capita - amounting to twelve percent of allBritish taxes - in comparison with the currentU.S. per capita spending of $294.

4

doctors' fees, or the expense of buildingnew hospitals, but because of the in­creased operating costs of the vastbureaucracy necessary to oversee soenormous a system. A man in Londoncan't get treatment for a headache with­out wrestling with a bureaucrat. And yetParliament is regularly cutting back onmonies for health needs.] The dis­tinguished English journalist AnthonyLejeune explained this in the India­napolis Star of July 12, 1969:

Money for the Health Servicehas to compete with other politicalpriorities. How it should be raisedand how it should be spent becomesubject to considerations of vote­catching rather than of pure medi­cal need. Result.' the Health Serviceis always starved offunds.

Yet the wretchedly inadequate "free"medical services in once-great Britainactually cost the average Englishman con­siderably more than an American pays forthe most expensive private health andhospitalization insurance . The LondonEconomist notes that "The British peoplesoon found out that as taxpayers theyhad to spend more money than they haddone before as patients."

Has Socialism improved medical carein England as its proponents guaranteed?The complaint of the London WeekendTelegraph of August 13, 1966, is typical."Almost everything is wrong withN.H.S.," says the Telegraph. "It gives badservice, it treats its staff meanly, it leavesbadly needed hospitals unbuilt , and, ontop of all this, it does not even give valuefor money ."

Doctor Lloyd Dawe, one of manyEnglish physicians who have in recentyears immigrated to the United States,comments on his experience with theNational Health Service:

As an intern in a London hos­pital and later in general practise

AMERICAN OPINION

there, I witnessed the unbelievablewaste, interference and bureau­cratic regimentation that have ac­companied Britain's unwieldy socialexperiment.

I paid government-imposed"fines" for prescribing the bestmedicine for my patients . I spentanxious hours in search of hospitalspace for the critically ill. I saw hos­pital grants frivolously spent . . . .

Practise under the NationalHealth Service soon became intoler­able for me, as it has for thousandsof British and European doctorswho have left their countries topractise in America . . . ' .

Anthony Lejeune says that undevN.H.S. "the average wait for a non-urgentoperation is 22 weeks, and the waiting­period may stretch to years ." ProfessorRussell Kirk reports: "People have towait up to seven years for treatment ofhernias or varicose veins."

One of the major problems in theEnglish system, as it is in any systemwhere the patient does not pay out-of­pocket for a visit to the doctor, isover-utilization. The Honorable EnochPowell, Minister of Health in the UnitedKingdom from 1960 to 1963, put hisfinger on the difficulty in his book ANew Look At Medicine And Politics,noting: "There is a characteristic of medi­cal care that makes its public provisionexceptionally problematic. The demandfor it is not only potentially unlimited ; itis also by nature not capable of beinglimited in a precise and intelligible way."Doctor Dawe looks at this problem fromthe point of view of the harassed physi­cian trying to practise medicine under theNational Health Service:

Since medical care theoreticallywas available to everyone at any­time, we were literally swampedwith patients, many of them withtrivial complaints or with no ail-

FEBRUARY. 1971

ment at all. I remember one elderlywoman who was in and out of theoffice three or four times a week.This old dear lived alone andmainly wanted someone to talk to.

Besides the heavy patient load,the time spent on government pa­per work was fantastically high.. . . Form-filling and correspon­

dence with the government thusbecame one of the physician'smajor functions. He was reduced tothe role ofpart-time clerk.

The N.H.S. provides a windfall forhypochondriacs who want company orsympathy and for malingerers seeking avacation from work. Anthony LeJeunereports that "General practitioners haveto spend an intolerable amount of timeform-filling and catering to people whotreat their National Health Servicedoctor as an automatic supplier ofaspirins, tranquilizers, laxatives and vita­mins. They may see almost as manypatients in a day as an American doc­tor sees in a week." And, either pas­sage of the N.H.S. worsened the stateof health in England or it has severelymultiplied malingering . Doctor Dawesays that "British businessmen foundthat absenteeism in plants and companiesnearly doubled the first year the HealthService was in effect."

Incredibly harassed, British physiciansare driven to attempt to reduce thecrowds in their offices by pushing pills atpatients in an effort to get rid of them.Donald Drake explains in the PhiladelphiaInquirer of December 19, 1969:

It is generally agreed that Britishdoctors tend to over-medicate butthe reason is simple: It's beenshown that British patients expectto get medicine from their doctorsand when they don't they tend tosummon the doctor more often forhouse calls. As one physician saidphilosophically, it takes less time to

5

write out a prescription than tomake a house call or a physicalexamination.

Accord ing to Pro fessor Joh n Jewkes,who served on Britain ' s Royal Commi ssionon Remuneration of Doct ors and Dent ists,more and more Britons are now seekingmedical care outside of th e NationalHealth Service. These people , he repo rts,are " ready to make sacrifices in othe rdirections in order to enjo y prompt hos­pital and specialist treatment , free choiceof consultant and private accommoda­tion ." A poll taken fifteen years after theNational Health Service was instituted inBritain showed that fifty -seven percent ofthe people there, including almo st as manyLaborites as Conservatives, now opposeuniversal and compulsory socialized medi­cine. But, once such a system is estab­lished , it is very hard to abo lish - nomatter how bad it is.

And it is bad. A recent PhiladelphiaInquirer series on medical care in Europe,which openly espoused socialized medi­cine for the United States, freely admi tsthat N.H.S. "is outrageously un fair todoctors." As Marjorie Shearo n, a legisla­tive specialist in such problems of health ,education , and welfare , has commented:"Today , British general practitioners arein a sorry state. Their income is wretched.The better the service they give,thepoorer is their remuneration. There is noway to prevent abuse of the syst em solong as patients have the unrestrictedright to make office visits when they arenot ill or when they have some trivialindisposition which does not requiremedical care." British physicians, you see,are paid on a "capitation" basis - that is,by the number of bodies th e doct or cansign up as "his" patients . Again we quoteDr. Shearon:

Physicians in Britain depend onthe size of their lists of patients,not on the number or quality ofservices rendered. One phy sician

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said to the Editor: "It is medicineby blackmail. I have to give theprescriptions they seek. If I don 'tthey will go to another docto r. Andyou know how women are, they'lltake all their relatives with them. Ican 't affo rd to lose them. "

Medical facilities in which the Britishdoc tor must practise have also suffe redund er Socialism. Most date back to theVicto rian Era . Paul Harvey observes that"In the 17 sta tes of the Sou thern regionof the United States (an area equal to theUnited Kingdom in populati on) therehave been 515 new hospit als constructedsince World War II. In all of Britain , the yhave built only 10 new hospit als since thebig war."

All of which has led many British doc­tors to vote against socialized medicinewith their fee t. Donald Drake reports inthe Inquirer that each year Brita in loses theequivalent of up to thirty percent of itsmedical school gradu ates to Canad a,Australia , and the United States. Many aBrit ish " med student" picks up his diplo­ma and his airline ticket the same day .Since th e N.H.S. was passed in 1948, thenumber o f students prep ared to make thesacrifices for a caree r in medicine hasgreatly decreased. Fewe r studen ts arestudying medic ine in England now than be­fore World War II. As a result of this de­cline, coupled with the emigra tion oftrained doctors, nearly half of all juniorposts in British hospital s are now filled byphysici ans from outside the United King­dom. Countries like India and Pakistanhave been drained of badly needed doc­tors to help fill vacanc ies left by thedearly departed in England. Even so, thequality of their skills is, to be gentleabout it , unreliable .

Little wonder that when ever Conser­vatives raise the matter of th e failure ofsocialized medicine in England , American"Liberals" become hype r-tense. It is bet­ter , they say, to discuss socialized med i­cine on the European Continen t. Not , as

A MER ICAN OPINIO N

we have discovered, because socializedmedi cine is any better there - but be­cause less is known about it in America.The fact is that socialized med icine onthe Continent faces the same problems ofdoctor sho rtages, debt , and overuse associa lized medicine everywhere. U.S.News & World Report fo r August 10,1970, comments on the cost of theFrench system , where the average workernow pays thirty -three percent of hiswages for such state services:

In France, where the Govern­ment pays about 80 percent of thef ees of physicians co-operating inthe national health plan, deficits aregetting out of hand. The social­security system's health fund willbe abou t 165 million dollars in thered this y ear. If present trendscontinue, the deficit could rise to1.8 billion by 1975 , French off i­cials say.

Leave it to the New York Times toeuphemize this into a French asset , de­claring that "As a result of all th eadvantages which th e system accords,its officials have noted with risingalarm but general helplessness, there isan o verwhelming eagerness amongFrenchmen to take good care of them­selves . . . . The doctors, the medicallaboratories, and the pharmaceu tical in­dustry , both manufacturers and retailers,are prospering as the deficit grows." Onecan only groan.

Germ any has a government medicalsystem administered by private insurancecompanies. Germans pay eleven percentof their salaries for government medicalcare ; half the cost being hidden since it ispaid by the emp loyer. As always "free"medicine means crowded offices and longwaits , driving fifteen percent of the popu­lation to buy extra private insurance. Thesituation is serious. As Donald Drakeobserves in the Philadelphia Inquirer forDecember 17, 1969 :

FEBR UAR Y, 1971

Germany has a shortage of hos­pital beds . . . .

Germany has only five heartcenters capable of performing anaverage of 3,000 open heart opera­tions a y ear when there is a needf or 12,000. A s a result, 9,000patients either die or, if they haveenough money , go to America andpay for the care out of their ownpocket.

Despite the shortage of hospital beds,and because "the government is payingfor it ," th e average German spends overtwice as long in the hospital as theaverage American. Drake says "the aver­age length of stay is ridiculously high ­more than twice that of an Americanhospital. The average length of stay in ashort-term, general hospital is more than19 days as compared to 8.5 in the U.S.A German maternity case stays in anaverage of nine day s." Why not , it's all"free," isn't it?

But it is Sweden that makes the heartof every American " Liberal" palpitatewith joy. It is not British Socialism orRussian Socialism th ey want , so the linegoes, but the sor t of practi cal , sensible ,efficient Socialism practiced in Scandi­navia! Marx apparently gains somethingin the translation int o Swedish.

If there is any place where Socialismshould work, if it is a viable system, it isSweden. A country smaller in populationthan Southern California , it has no racial ,religious, or lingual varieties. It has astrong "work ethic" and a centralizedpopulation. And of course the Swedesprofited from the two World Wars insteadof depleting their human and financialcapital by participating in them. Onewould think that Sweden should be send­ing us foreign aid and providing for ournational defense instead of vice versa.

Yet , even with every advantage , Social ­ism in Sweden has proved seriously debili­tating. U.S. News & World R eport for Feb ­ruary 7 ,1966 , revealed just how phony the

7

Fabian paradise really is. Alcoholism, sui­cide, and venereal disease there are amongthe highest, if not the highest, in the West­ern ' world. Crime is spiraling and Welfaredemands are proving to be insatiable.Swedes now pay a staggering twentypercent of their taxes for socializedhealth care - the highest in the world.

At the time Swedish doctors werenationalized, seventy percent of thepopulation already had private insuranceprograms. In the name of equality, how­ever, those seventy percent were forcedinto compulsory government programs inorder to provide super-benefits for theremaining thirty percent of the popula­tion not privately insured. And, as U.S.News has observed, "The present systemis proving anything but a clear-cut suc­cess." There is now hardly a hospital inSweden where there isn't a long waitinglist for every sort of hospital care. Con­servative estimates are that in Stockholmthere are more than four thousand per­sons now waiting to enter hospitals . Thewaiting period for minor operations is upto six months. Consider this report fromSweden in UiS. News & WorldReport forJanuary 24, 1966 :

The average patient here findshis situation has worsened ratherthan improved. It is more difficultfor him to get a doctor. He mustwait longer to get into a hospital.And he may be forced to leave thehospital before he is medicallyready for discharge . . . .

Overburdened doctors must turnaway thousands of patients an­nually - many of them old peoplewho badly need medical care . . . .Waiting periods for special treat­ment are sometimes so long thatpatients become incurably ill, evendie, before they can get adequatecare.

Gravely ill patients, in need ofimmediate treatment, had to beturned away from hospital emer-

8

gency rooms. There were notenough medical personnel on handto take care of them.

The fault, of course, lies with socializedmedicine. Swedish writer Nils Brodin isquoted in Human Events for October 24,1970, as explaining that "the increase inutilization of existing facilities comes fromthose who demand 'hospital vacations.'When the tensions of life or home get toointense, many will 'rest up' in a hospital.Often a patient stays in a hospital a weekbefore he is diagnosed, and even then thediagnosis may be hasty and inadequate.'I'm paying for it . . . I've got it coming' isthe attitude." Dr. Dag Knutsson, head ofSweden's medical association, estimated inthe first years of the medical plan that halfof the patients in Sweden's hospitals"need not be there."

The Swedish government, in order torelieve the shortage of doctors, has re­duced the quality of care by choppingtwo years off medical school curriculaand filling many positions with internsand students. Sweden has also imported alarge number of foreign doctors . Yettoday Socialist Sweden has fewer phy­sicians per capita than the United States,West Germany, Austria, or even Italy . Itis part of the syndrome of socializedmedicine that nationalized health caredrives up costs , drives down the qualityof care, and drives out physicians.

About one-seventh of Sweden's doc­tors have managed to defy the govern­ment to remain in private practise, andthey treat thirty percent of the Swedishpatients who seek private care despitepaying the staggering taxes for state care.Even so the Swedish government isplacing pressures on private physicians totry to force them into the governmentmaw. All private and semiprivate care isbeing gradually eliminated as something"anti-egalitarian ." There are very fewprivate hospitals, and private nursinghomes are being forced out of businessbecause of excessive taxation.

AMERICAN OPINION

j

f

In summing up the situation undersocialized medicine in Europe the Phila­delphia Inquirer declared in its lengthyexamination of these matters that "Noneof the European systems stu died offeredsubstan tial incentives to doctors to do asuperio r job . Many of the m, in fact ,reward inefficiency."* And, the Phila­delphia paper admits : " Most experts sur­veyed in Europe said that the top careprovided in the U.S. is secon d to none inthe world ."

But American "Liberals" are busybuilding the impression that Americanmedica l care is not the best in the world.Inevitably these attacks on the quality ofAmerican medic ine are "documented" byciting infant mortality stati stics as proofthat American medic ine is second- rate atbest. Seldom are any other criteria men­tion ed. Typical is this statement from thewidely syndicated Sylvia Porter :

We may boast we have the mostadvanced health care services in theworld. But the fact is that since1950 we have dropped from sixthto thirteenth place in infant mor­tality - behind such nations asJapan, Finland, New Zealand, EastGermany . . . .

This is a disgrace in a nation asrich as ours.

This is the reason why "social­ized medicine" is about to becomea fact of u.s. lif e.

The statistics come from the U.N.World Health Organization's Demo­graphic Yearbook. And Sylvia Porter andthe others who use them as propagandaknow very well the Yearbook specificallywarns that such figures should not beused f or comparison because the stan­dards of measurement for different na­tions vary . Many variables affect -thesestatistics. The methods used are not evenuniform in the Unite d States, each statehaving its own requirements.

Report s of births in many countries

FEBRUARY. 19 7/

are the responsibil ity of parents; but asthere is no punishment for not reporting,a sizable percentage of infant deaths gounrecorded . In the United Sta tes theattending physician is responsible forcertifying births and deaths , and all areimmediately reported. Here , too, oneheart bea t means a live birth. But in othercountries this is not so: In Sweden , forexample, a birth is not counted unless thebaby lives through the dangerous firsttwenty-four hours. And Swedish parentshave five y ears to report a birth, with theresult that deaths of children up to agefive are often excluded from the statis­tics. In the U.S.S.R., infant deaths are notrecorded if they occur within twenty­eight days after birth. In parts of Ger­many , a baby is not registered as havingbeen born until he is baptized - again,affecting the infant mortality records.The impact of legalized abortions onreducing the incidence of recorded infantmortality is not now known, but it isobviously significant in countries such asJapan where it is generally available.

The point of going into all of this , how­ever briefly, is that in the oft-cited field ofinfant mortality the " Liberals" are com­paring apples with potatoes in a situationwhere we are keeping accurate records by astrict standard and no one else is. Thereare, of course, areas where you can meas­ure the relative quality of health care . Forinstance, many of the countries cited in therigged statistics as having a lower infantmortality rate have two to three times therate of tuberculosis, a leading killer ininfectious diseases.

The fact of the matter is that social­ized medi cine has nowhere improved

• Ple ase keep in mi nd th at while we haveseverally qu oted the Inquirer's length y se ries o nthi s su bjec t, these are ad m issio ns aga inst in ter ­est. Author Donald C. Drake makes no bon esabou t the fact that he is for socialize d medicineon th e gro und that it is the o nly sys tem thatguarantees medical care fo r eve ry o ne. Tha t italso severely reduces th e quality of medical ca refor everyo ne is not so imp ortant to h im as hisega li ta rian commitment.

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medica l care. Even the proponents ofMarxist med icine no longer claim thatdoctors will be better doctors under agovernment system. Political medicineproves to be bad medicine. Ask anydoctor who has served in the military ifhe was concerned about the health of hispatients before he went into the service.He will tell you that he certainly was.Then ask him if his attitude changedwhen he was in the military, and he willtell you that it was imposs ible to have thesame concern. Military medicine is massmedicine, with little of the doctor-patientrelat ionship. Yet he was the same man inboth situat ions . While working for him­self he was a good do ctor; while workingfor the government he was less so. Thedifferen ce wasn' t in the doctor , bu t in thesystem . The collect ivists are now worki ngto replace a personal system of volun taryexchange with one of cattle-car medicine.

Doubtless few Ame ricans wou ld evenconsider socialized medicine if projec­tions of the cost of future medical carewere not so frightening. US. News &World Report for August 10, 1970 , of­fered these statistics:

Spending on health care, byindividuals and governments, ismore than five times as large as itwas just two decades ago. In 1950,outlays for health took a nickel outof every dollar spent in the Us. forgoods and services. By 1975, healthcare will take almost 9 cents ofeach dollar.

The project ion will no doubt proveaccurate if we get more socializedmedicine, bu t the statement is h ighlymisleading. It does not take into con­siderat ion th e vast exp ansion of pop u­lation in the past twenty years, no r thetremendous inflation which has driven upall prices. Medicine is being used bypolit icians as a scapegoat for inflation ­which on ly the poli ticians can cause. *Iron ically, the same manic -progressive

FEBRUA R Y, 1971

deficit po liticians who caused the in­flation of medical costs now pretend towant to save the pub lic through furtherdeficit spen ding for social ized medicine.

The truth of the matter is that thegreat increase in infla tionary governmentspending over the last decade has beenlargely a product of the efforts of theDepartment of Health, Education andWelfare, which is already knee-deep inmedicine and wants to be neck-deep.That Department now spends more thanall the profits after taxes of all thecorporations in the United States.(Corporate profits are $49 billion,H.E.W. spen ding is $58 billion .) Infla­tionary government spending for H.E.W.is now seven times the total amo unt offederal spending in 1940 . Yet, whilethey increase deficit spending more andmore - which alone causes inflation ­the po liticians blame doctors for theinflation of medical costs.

Highly tra ined doctors, supple­mentary personnel, soph isticated equip­ment and drugs, are all expensive . Butadvances in tra ining and techno logy al­low our doctors to be ever more effi­cient, and this is reflected more in thequality of American medical care thanin its cost. The average American staysin the hospital 8.5 days . The averageSwede's stay is fifty percent longer, as isthat of th e typical Englishman, and theaverage German stays in the hospitalthree hund red percent longer.] Figuringcosts on a daily basis, the do llar savingsto the patien t are obv ious. Prop agandistsfor government medic ine always point tothe high costs of hospitalization , but the yforget to menti on that because of thequality of our system Americans spendmuch less time in hospitals than do tho sein countr ies where socialized medici nehas a strangleho ld.

*Innation is an increase in the money su pp lywh ich bids up wages and prices. It is ca use d bydefi cit spen d ing.tSee Co ngress io na l Record, Dece mber 12,1969, Page S 17334.

I I

The fact is that the cost of medicalcare has not even kept pace with othernecessary commodities and services. Achart in U.S. News & World Report forDecem ber 8, 1969, illustra tes that in thepast two years the cost of medical carehas risen 12.9 percent while meats are up13.6 percent, the cost of owning a homeis up 18.2 percent, men's clothing is up12.8 percent, shoes are up 12.7 percent,and public transportation is up 13 per­cent. Doctors' fees rose an average of 3 .7percent per year between 1956 and 1968,while average wages in general rose 4.2percent. It now costs less to visit a doctorthan to call a plumber or televisionrepairman. Even the Philadelphia Inquirerconcedes that doctors' fees are a mini­scule part of total health costs:

Many persons angered by thehigh income of doctors in the U.s.hold the simplistic view that healthcare costs could be held down bysimply reducing physicians' in­comes.

This would have only a minoreffect.

If the income of the nation's280,000 physicians was cut bymore than half to a ridiculously low$17,000 annually - a foolish movethat could destroy American medi­cine - the national expenditure forhealth care would be cut by apaltry eight-tenths of 1 percent.

Much of the pressure which is pushingup the cost of medical care comes fromthe government - which already paysfor thirty-six percent of all medical carein the United States. u.s. News & WorldReport for August 10, 1970, quotesMerle A. Gulick, vice president of theEquitable Life Assurance Society, assta ting that it is "significant tha t allmedical-care prices have accelerated since1966, the year Medicare began. Hospitalprices have risen at the rate of about 15percent, and other medical-care com-

12

ponents have risen about 6 percent."America is already beginning to pay forthe over-utilization that inevitably accom­panies "free" medicine. As Lancet, theprestigious British medical journal, hasobserved:

If taxi fares were abolished and afree National Taxi Service was fi­nanced by taxation, who would goby car or bus or walk? The "short­age" of taxis would be endemic andthe "taxi crisis" a subject ofperiodic public agitation.

One does not have to be an economistto realize that an unlimited wish forsomething of value is impossible to sup­ply. If politicians promoted Cadillacs atgovernment cost to everyone for theasking, General Motors could never meetthe artificial demand. The same is true of"free" socialized medicine. When demandexceeds supply prices go up.

Besides the flooding of doctors' officeswith Medicare and Medicaid patients,there is also an influx of union memberswho are totally covered by company­provided insurance. As one Midwesternphysician told your correspondent:

"First dollar" insurance cover­age, whether it be from the govern­ment or from a private company aspart ofa union negotiated contract,is basically unsound. Since no fee isinvolved people come into the office every time they have thesniffles or need a Band-Aid changed.It costs an insurance company andthe doctor about $10 in administra­tive costs alone for a call that theperson would not make if he werepaying for it himself

I practise near a General Motorsplant. Absenteeism there runs threeor four percent from Tuesdaythrough Thursday and fifteen per­cent on Fridays and Mondays. Doc­tors' offices are flooded with peo-

AMERICAN OPINION

pIe who aren't really sick but whowant a slip from the docto r onsome imaginary pretext so they cango hunting or take a vacation. Sincethey get a given number of days ayear in sick pay they use every dayof it and it doesn't cost themany thing. All of this only escalatesthe cost ofmedical care and crowdsdoctors' offices with kooks andmalingerers.

The introduction of Mr. Nixon's Na­tional Health Insurance will multiply thispro blem a hundred-fold. And of coursethe taxpayer will be asked to support awhole new layer of bureaucrats to admin­ister the program. If other federal pro­grams can be used as a guideline, therewill probably be at least one paper-shuf­fling bureaucrat at an average salary of$12,000 per year for every practisingdoctor. The administrative cost of Medi­care and Medicaid is estimated already tobe greater than the doctor cost, while theadministrative cost of private insuranceprograms runs at only about thirty per­cent of the premium. The current cantabo ut the "high cost of med icine" as anargume nt for nationalizing our healthindustry is as phony as Dr. Quack'sCancer Cure .

Another of the often mentionedreasons why we must install more social­ized medicine is the allegedly inadequate"delivery system" - "Liberalese" forhaving too few doctors to take medicalcare to the people. It is alleged thatfederalized medicine will produce enoughdoctors to inspect every wart and rash inthe nation. Which ispure ba lderdash!

There are 3 18,000 medica l doctors inthe United States. With a national popu­lation of approximately 200 million, thisis an average of one doctor for every640 persons. No other major nation inthe world enjoys anything close to thisratio . . Of these doctors , 170,000 areengaged in full-time private practise and20,000 are in part-time private practise.

FEBRUARY, 1971

The remainder are mostly employed ingovernment service, research, teaching,and administration. The problem is notthat there are not enough graduatingdoctors, but that too few are in directpatient care.

The more than 30,000 doctors now ingovernment and administrative work, ifretu rned to private practise, woul d beadequate to care for three cities the sizeof Los Angeles. Of course this is im­practical, but who will doubt that federal­ized medicine would mean tying morephysicians into such tasks?

Would there be more doctors if wewere to have a system of National HealthInsurance? England had 44,000 phy­sicians before institu ting socialized medi­cine . The National Health Service hassince pro duced a gigantic implosion, andas a result Brita in now has only 23,000doctors. If American medicine is turnedover to the federal bureaucracy we canexpect that fewer, not more, young menwill be attracted to the profession. Andof those who do study medicine, morewill be government administrators ratherthan practising physicians.

Bureaucratic complaints about a faulty"delivery system" really boi l down to thefact tha t more doctors prefer to practisein Beverly Hills than in Watts. This shouldnot be too surprising since even the mosthumanitarian physician does not ap­preciate being mugged. But it is also truethat people get sick in Watts. So what todo? Certainly socialized medicine is notthe solution. The shortage of doctors in"ghetto" areas might be greatly alleviatedwithout government compulsion if thefoun dations and such organizations as theN.A.A.C.P. and Urban League would stopplay ing revolutionary games long enoughto run campaigns recru iting young phy­sicians to practise in Negro neighbor­hoods and rural areas, meanwhile offeringscholarships and loans and special prepar­atory training to qualified Negroes seek­ing to become medical students.

The only other alternative is for the

13

government to shanghai doctors forforced service in minority areas , or paythem large subsidies to serve there . Suchsolutions not only assume the inferiorityof the minority people but introduceforms of compulsion alien to Americantraditions. Clearly, whatever problemsexist with our medical "delivery system"cannot be solved by socialized medicineshort of taking away from the physicianhis Constitutional right to decide wherehe will work. This is a problem for theprivate sector - one which can be solvedby urging the foundations, for example,to make it a priority consideration.

There is a whole cart-load of suchphony issues of course . What is behindthe move for socialized medicine is not adesire to solve problems but a drive onthe part of collectivists to extend theirpower. According to U.S. News & WorldReport of August 10, 1970, some 176million Americans are covered by someform of private health insurance.*Another thirty million have either optednot to buy insurance, neglected to buyinsurance, or cannot afford insurance. Itis for the latter-third of the approxi­mately twenty percent that the othereighty percent would be forced to sup­port the inefficiencies and destructivenessof compulsory government medicine.

Under freedom there will always be afew who must accept charity. Butcharity, we are assured by the proponentsof socialized medicine, is demoralizingand degrading to the recipient when it isprivate , but somehow moral and upliftingwhen it is done at the point of agovernment gun. This is known as "re-

'In 1948 Oscar "Ewing, President Truman'sFederal Security Administrator, was champion­ing socialized medicine with the declarationthat "at a maximum, only about half thefamilies in the United States can afford even amoderately comprehensive health insuranceplan on a voluntary basis."tSomeday, such politicos will be held ac­countable not for what they have done for thepeople, but what they have done to them. Butthat day has not yet arrived.

14

sponding to the challenges of our times."Fastening socialized medicine on allAmericans because of the few poor whomwe will always have with us is thehyperbolic equivalent of using a guillotineto perform a tonsillectomy.

Okay, if it's so outrageously stupid,why the big push for National HealthInsurance? Because, simply, there aremany advantages in such a scheme forits promoters. Most of those in themedical profession who favor socializedmedicine are already on the govern­ment payroll or stand to gain finan­cially by more government spending inthis area. The advantage for the poli­ticians is obvious. Middle-class Ameri­cans, their savings ravaged by govern­ment inflation, will become captives ofpoliticians who will promise each elec­tion to escalate medical benefits.] AndLeftist conspirators are pushing gov­ernment medicine, as they have alwaysdone, because medical control meanspeople control. Lenin described socializedmedicine "as the key to the arch of asocialized state."

One of the two men most responsiblefor promoting socialized medicine in theUnited States was the late WalterReu ther, a Soviet-trained radical whopushed for "first dollar coverage" inindustrial medical insurance and organ­ized the committee which prepared theplan for socialized medicine being spon­sored by Senator Kennedy. The Kennedy"Health Security Program" was devel­oped by the Committee for NationalHealth Insurance, which advertises itselfas "non-partisan." The current chairmanis Leonard Woodcock, Walter Reuther'ssuccessor as president of the United AutoWorkers.

The other chief proponent is Wilbur J.Cohen , head of the Department of Health,Education and Welfare under LyndonJohnson. Cohen, an out and out Marxistwho now serves as an advisor to NelsonRockefeller, has been working for social­ized medicine from within the govern-

AMERICAN OPINION

ment for over thirty years .* He has alsoworked closely with the InternationalLabor Organization in Geneva which hascoordinated the establishment of social­ized medicine all over the world. Duringthe last session, acting on testimony fromA.F.L.-C.I.O. president George Meanythat the I.L.O. was a Communist-domi­nated organization, Congress cut off allU.S. funds assigned to support it.t

Leftists have made several attempts toimplement socialized medicine as a wholeball of wax. After the last failure underPresident Truman in 1947, the collec­tivists switched strategies and adopted theapproach of Fabian gradualism. As Jef­frey St. John of the Copley News Servicehas observed:

Advocates of socialized medicinein America began promoting amedical dictatorship disguised inhumanitarian terms, knowing thenation would not accept a singleone-shot Socialist package. Theypreferred tyranny on the install­ment plan or using the piecemealapproach.

"It is not easy to convert a freecountry into a totalitarian dictator­ship," observed New York ProfLeonard Peikoff during the 1962debate over the King-Anderson gov­ernment medical package. "Thosewho attempt it know they mustmove gradually, by a series ofprecedent-setting steps. "

The forerunner to the Medicare pro­gram was the Forand Bill. The Commu­nist Party of Illinois distributed a bro­chure entitled "The Forand Bill Can BeWon Now!" This brochure, under thesubtitle "The Forand Bill Is The Mini­mum," described the Communist strategyon socialized medicine as follows:

The virtue of the Forand Bill isthat it is a Federal rather than aState-aid measure and is built into

FEBRUAR Y. 1971

the Social Security system. With allits present limitations, the ForandBill opens the door toward com­plete hospital, medical and surgicalservices for the aged - and ulti­mately for the whole population. Itcan be enacted at once by thissession of Congress.

Forand himself said almost the samething about Medicare after J.F.K.'s WhiteHouse Conference on the issue. "If wecan only break through arid get our footinside the door," he declared, "then wecan expand the program after that." TheForand Bill did not pass, but it survivedto become J.F.K.'s Medicare program.

The whole collectivist menagerieunited behind the passage of Medicare. Inthe April 1965 issue of the officialCommunist Party organ, Political Affairs,the Comrades were formally directed tofight for passage of Medicare as "the mostimportant single piece of legislation to­day." But neither the Communists northe Fabian Socialists who pushed forMedicare and Medicaid considered themanything but a step in the Left direction.Reporter St. John writes:

Liberal advocates of govern­ment-dictated medicine knew thatpassage in 1966 of Medicare andMedicaid, which the AMA feeblyattempted to defeat, was a steptoward a National Health Insuranceprogram. Such lawmakers also

*Wilbur Cohen has formally affiliated himselfwith the Washington Committee for Aid toChina, cited in the government's Guide ToSubversive Organizations as "Communist con­trolled"; the Washington Committee for Demo­cratic Action, cited as "subversive and Commu­nist"; and, the Washington Boo ksh op Associa­tion, cited as "subversive and Communist." Hehas refused to repudiate his Communist as­sociates and the Soviet Fronts to which hebelonged.tCongressman John Rousselot tells me it is hisopin ion that it was the death of Reuther whichpermitted Meany to give such damaging testi­mony .

15

YES, WE AREPROUD OF

AMERICAN OPINION MAGAZINEWe co unt amo ng our co nt ribu to rs such outs tanding au tho rs as th e wo rld 's

best-selling nove list , Taylor Caldwell , suc h na tionally respected journalists asAlan Stang, George S. Schuyler, Harold Lor d Varney , David E. Gumaer, GaryAllen, and David O. Woodbu ry; as well as int ernation ally renow ned academi cian slike pro fessors E. Merr ill Root , Medford Evans , and Susan L.M. Huc k.

We broke the first natio nal story o n the Black Muslims and predic ted th eBlack Pow er movem ent lon g before it develop ed . We ex pose d Co mmu nistinfluence in th e Califo rn ia gra pe st rikes, in Marti n Luther King's S.c.L.C. and inthe Castro ite Tije rina Movem en t of th e Ame rican Southwest. We establishedF ide l Cas t ro 's Co mm u nist backgrou nd long before he was brou ght to power. Wedoc umen ted Commun ist in filtrat io n of the " War on Povert y" - as alway s wit hus, naming the nam es and citin g the det ailed proo fs. We covered the holocaustsin Watts, Det roit , Newark, Washington , Clevelan d, and othe r cities dir ec tly fromthe scene - telli ng wha t o thers refuse d to tell abo u t Communist particip a tion .We det ailed th e Co mmu nist manipulat ion of such Fronts of th e Far Left as theS.O. S. , R.A.M., and a number of o thers, more th an a year before they began tomake hea dli nes . We have regularly pu bl ished detailed ex poses of th e Commu nistsin the Press and Fo unda tio ns . And, well . .. what else do yo u need to knowabo ut us?

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knew the private medical systemcould not meet the demands Medi­careand Medicaid created.

No enormity was spared in lying abouthow little Medicare wou ld cost. With astraight face that must have been theenvy of Jack Benny , President Johnsondeclared on Ja nuary 9,1964:

We must provide hospital insur­ance for our older citizens financedby every worker and his employerunder Social Security, contributingno more than a dollar a monthduring the employee's workingcareer to protect him in his old age,without cost to the Treasury.

A dollar a month, and at no cost tothe Treasury! Who cou ld refuse a deallike that? Congress passed Medicare in1965 , providing benefits for everyoneover sixty-five regardless ofneed.

Why didn't the American MedicalAssociation stop it? Reliable sources tellme that President Johnson met in privatesession with H.E.W. chief Wilbur Cohenand several top staffers of the AmericanMedical Association shortly before thepassage of Medicare. The members of theA.M.A. staff told Mr. Johnson there weretwenty-one particulars in the Medicare Billto which they objected. The President isreported to have turned to Cohen and said,"Wilbur , I want you to meet with thesemen and make them happy." Twenty ofthe twenty-one objectionable items weredeleted from the bill and A.M.A. opposi­tion was reduced to a whisper. The Fabianswere willing to make almost any conces­sion to get that "foot in the door,"knowing they could handle it from there.

After the bill was passed, the Depart­ment of Health, Education and Welfarereinstated virt ually all of the features towhich the A.M.A. staff had objected bythe simple expedient of inserting them asExecutive Orders in the Federal Register,where after thirty days they have the

FEBRUARY, 1971

power of law. The doctors had beenmou se-trapped.

The reception among the people whowere supposed to be unab le to survivewithout Medicare was a curious one. Thegovernment had to put on a huge salescampaign, complete with urgings fromHollywood stars and sports personalities,to get people to sign up for the program.The New York Times of January 23,1966, repo rted :

The Federal Government is en­gaged in one of the biggest "sales"campaigns since its great effort in1936 [date given incorrectly as1926] to sign up an estimated 26million eligible workers under thenew Social Security Act . . . .

The [Social Security] agencyhas run a personal-interview checkon a large sample of those who havedeclined to find out their reason.These fall into three main cate­gories:

(1) Many said they already haveinsurance, or have been so healthythey don't need it.

(2) Many others said theycouldn't afford the $3 premium.

(3 ) A smaller but significantnumber said they opposed thewhole scheme on political or similargrounds. .

But the Socialists in Washington heldthe ace of trump. President Johnsoncalled in the heads of the major insurancecompanies for a secret meeting. It is notknown what promises or threats weremade, but all the major carriers began tocancel their policies on those over agesixty-five on the same day . It was hardlya coincidence.

While promoting Medicaid in Congress ,"experts" from the Department ofHealth, Education and Welfare had con­tended that Medicare wou ld cost $2billion per year. They deno unced conten­tions of doctors and insurance actuaries

17

tha t the program would cost over $5billion per year as fright-mongering bygreedy doctors and ot her vested interests.Who was right? In 1970 Medicare cost theAmerican taxpayers some $7.8 billion,and the combined Medicare-Medicaid billwas $14 billion. As Senator John Williamshas observed:

Without a modif ication in theprogram the total costs of parts Aand B of medicare during the nex t25 years will equal or exceed thepresent national debt of about$370 billion. The latest report ofthe trustees of the hospital insur­ance fund states that under presentf inancing that fu nd will be brokeby 1976 ....

Whatever happened to L.BJ.'s dollar amonth with no drain on the Treasury?Tsk, tsk!

Now, of course, the Department ofHealth, Educat ion and Welfare is lookingfor a scapegoa t on wh ich to blame its 300percent "error." As you know, the doc­tors who warned it wou ld happen havebeen nominated. It has been widely de­clared that some doctors are profiteeringfrom the progra m, but it has gone unre ­ported tha t the records of the Socia lSecurity Adminis tra tio n show that du ringfiscal 1969 doctors received on ly eigh teencents of each Medicaid and Medicaredollar. The scapegoa ters also claim thatdoc tors charge wha t they please underMedicare and Medicaid, and are callingfor ceilings. The fact is that ceilings wereplaced on doctors' fees for Medicare andMedicaid in January of 1969! It has hadlitt le effect on the overall cos t.

Much publicity has been given to on edoctor in Colorado who is said to havereceived $326,000 in Medica re fees in1968. The scapego aters didn' t know, orneglect ed to mention , that th e $326 ,000actually went to 124 physicians atColorado General Hospital. One doctorhad signed the bill fo r the entire med ical

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staff, a procedure au thorized by theMedicare law.

It has also been widely repo rted that2,500 doctors earned $25 ,000 or morefrom Medicare in 1968. Unreported is thefact that this represents only three per­cent of the doctors treating Medicarepatients. Furthermore, of those involved,a majority specialize in the treatment ofthe elderly who comprise the bulk oftheir practise.

Doubtless there has been fraud insome cases. Two (repeat, on ly two) doc­tors have been convicted . "Free" cash at

Ithe government trough always attractsthe greedy . But the major reasons for thefantastic excess of cost over fruga l prom­ises are the inevitable over-uti lizat ion andspiraling overhead caused by the endlessreams of paperwork, forms, and regula­tions common to all government projects.

One of the first devices designed bythe Department of Healt h , Education andWelfare to put the blame on doctors forthe skyrocketing costs of governmentmedicine is the esta blishme n t of "PeerReview Boards." These Boards would becomprised of local doctors acting asH.E .W. agents who wou ld snooperv iseothe r local doctors . At a recent conven­tion of the American Medical Associa­tion , Tom Tierney of H.E.W. told theassembled doctors th at he was glad phy­sicians are accepting the idea of "control"and that "contro l was no longer a dir tyword." He said there is going to becontro l of the medical profession, butthat he hoped doctors would controlthemselves thro ugh Peer Review Boardsrathe r than be contro lled by "others."

This is quite a mouse trap . A bill toestab lish Peer Review Boards is nowbefore the Senate. Under this legislation,if H.E.W. does not believe that the Peerdoctors are doing a good jo b of playingBig Brother, and keeping down the risingcosts of Medicare and Medicaid , then thefederal government can send in its ownmen to supervise local doctors. The A.M.A.favors a similar, th ough slightly watered-

AMER ICAN OPINION

down, version. As usual in medical politics,doctors find themselves faced with achoice between false alternatives. Aformer member of the A.M.A. staffanalyzed the situation for me this way:

If the medical profession acceptsthe A.M.A. plan it assumes thepublic responsibility of holdingdown costs for unlimited demand.When the profession fails to accom­plish this impossible task, as itwould, and costs continue to risedue to artificial demand, publiccondemnation would pave the wayquickly for the final victory of thecompulsory nationalizers.

The A.M.A is believed by the public,and by most doctors, to be a fierceopponen t of socialized medicine. Untilrecently this was true. The A.M.A. hadlong been a bete noire of all "Liberals,"but times have changed . And so, unfor­tunately, has the A.M.A

The medical profession is, basically,divided ideologically Left and Right be­tween doctors in private practise whocharge a fee for services rendered andsalaried doctors who more often than notwork either directly or indirectly for thegovernment or the unions. Less than adecade ago salaried doctors made up onlythirty percent of the population of theU.S. physicians. Today they make upnearly forty-five percent of our doctors.

Physicians in private practise think theA.M.A. is their organization. In 1962those in private practise made up ninetypercent of the AM.A.'s membership. Buttoday the increase in doctors beholden tothe government has greatly affected thecomposition of its mem bers hip - to whatdegree the A.M.A will not say. That thesalaried government doctors are veryactive is beyond question. Representedon the permanent staff, or as delegates toA.M.A. conventions, are H.E.W. em­ployees, Public Health Service doctors,Veterans Administration physicians, union

FEBRUARY, 1971

doctors, medical faculty and researchers,plus representatives of Blue Cross andBlue Shield (who as fiscal agents for thegovernment in its medical programs havebeen rabid promoters of governmentmedicine). These people are almostalways loyal to their source of income ­which stands to expand as the govern­ment gets ever more into medicine.

Meanwhile, the typical physician inprivate practise is almost totally unawareof the serious changes which A.M.A. hasundergone . He still believes that theAmerican Medical Association is a bastionof Conservatism and the zealous guardianof private medicine.

But the story of the change in theA.M.A., which as short a time ago as1962 organized the defeat of J.F .K.'sMedicare program, is the story of achange in the orientation of the A.M.A.'spermanent staff. The policy-making bodyof the American Medical Association is its222-member House of Delegates, mostelected by state societies, which meetstwice a year to vote on A_M.A. policiesand programs. Between meetings, theA.M.A. is governed by a board of trusteeswhich in turn appoints an Executive VicePresident who is the day-to-day boss ofthe 700-man staff in Chicago. While intheory it appears that there is strong localcontrol over the national A.M.A., inpractice the staff does pretty much whatit wants to do. This was a source of greatcomplaint for "Liberals" in the days ofyore, but today it is the Conservativeswho are complaining.

The real power at the A.M.A nowresides in the hands of Execu tive VicePresident Ernest Howard. Dr. Howard is agraduate of the School of Public Health atHarvard. Following his grad uation, heassisted in setting up socialized medicinein Peru while working for the PublicHealth Service. When he applied for astaff position at the A.M.A. followingWorld War II, severa l members of theboard of trustees were planning during hispreliminary appearance before the board

19

Ito grill him closely on his attitudes abo utsocialized medicine. But Howard upstagedpotential opponents by announcing at theoffset that he did not want to get the jobunder false pretenses, explaining that hisreal name was not Howard but Cohen.What that could possibly have to do withanything is unclear. But, impressed by theyoung man's apparent openness, thetrustees did not question him about hisSouth American activities and approvedhim as an addition to the staff.

Howard's stormy personal life has attimes been an embarrassment to theA.M.A., but it is his manipulating behindthe scenes that makes him a threat to medi­cal freedom. While taking strong publicstands against socialized med icine over theyears, Ernest Howard has worked cover tlyto torpedo effective opposition to a gov­ernment takeover. Former A.M.A. staf­fers and doctors who have worked closelywith Howard tell me they consider himcunning, ruthless, and brilliant.

It was Dr. Howard who ran the palacecoup in which former Executive VicePresident F.J.L. Blasingame, a staunchfoe of collectivized medicine, was oustedin September 1968, with four years torun on his second five-year contract.Howard then maneuvered his own ap­pointment as Dr. Blasingame's successor.

Since his rise to power by coup, after along career of patient gradualism,* ErnestHoward has staged a systematic purge ofthose members of the staff who weresolidly opposed to collaborating with thegovernment in arranging a sellout of theprivate phys ician to socialized medicine.These ex-A.M.A. employees believe the

• As far back as July 7, 1961, Time magazinenoted : "Insiders nominated Bert Howard as thesingle most powerful individual. Though tech­nically assistant to Bing Blasingame he domi­nates policy making , chairs the 'Legislative TaskForce ' that keeps a hawkeyed watch on federallegislation, and swoops in to figh t bills that runcounter to A.M.A.'s principles. The head­quarters' permanent staff inevitably wieldsgreat power. No one-year President ... candislodge it."

20

Association hierarchy has already cometo terms with the H.E.W. planners. Aformer department director at A.M.A. hasprepared "A Report To The MedicalProfession" on what is happening. He ob­serves what he cites as "speculation that astrong antagonism toward governmentintervention in medicine is detrimental toan employee's chances at the A.M.A."The "Report" reveals:

.. . Few physicians are awarethat an ideological conflict has splitthe Board of Trustees betweenthose who would collaborate withgovernment and those who wouldstrongly resist government interven­tion in medicine, that moraleamong the headquarters staff hassunk to a tragically low level in thepast few months, and that theseconditions are sapping the strengthand vitality of the AMA and under­mining its ability to represent effec­tively the scientific and economicinterests of the medical profession.

As the "Report To The Medical Profes­sion" indicates, the A.M.A. has been re­treating ever since the "hawkeyed" ErnestHoward "lost" the Medicare battle:

The American Medical Associa­tion s abrupt Medicare defeat aftermany victories in the long andexhausting war against it left theBoard of Trustees in a state ofconfusion from which it has nevercompletely emerged. Since then,the AMA has been drifting, unableto mount effective programs in anyarea. It has become increasinglyvulnerable to pressures of the gov­ernment interventionists and theschemes of labor bosses and otherswho seek to manipulate the AMAfor their own invidious ends.

Those close to the situation know thatthis "drifting" is no accident. While ex-

AMERICAN OPINION

pressing regret and dismay every step ofthe way , the A.M.A. staff is now workingfor more and more collaborati on withthose who would nationalize medicalcare. As the "Report" comments:

There is disquieting evidencethat the collaborationist fo rcesgrow stronger, the resistance forcesweaker. A conservative member ofthe Board [Dr. Edward Annis] toldfriends and supporters when he wasa candidate f or election that he wasalarmed at the AMA's drift towardappeasement and that if elected hewould reverse that drift. Recently,he had told friends he has grownweary of fighting a losing battleagainst the appeasers within theAMA. As the collaborationist phi­losophy grows stronger, AMA 's willto resist government intervention inmedicine will grow weaker.

Th e A.M.A. now advises doctors tofight socialism by imit ating it. The Depart­ment of Health , Education and Welfaremakes demands in excess of what it reallyexpects, and the A.M.A. staffers then pro­duce the face-saving syn thesis which iswhat H.E.W. wanted all along. Lip serviceis still paid to the concepts of Free Enter­prise, but then doctors are told , " We hadbett er make the best deal we can or thegovernmen t will really make thi ngs to ughfor us." It is like the condemned manbeing carefu l not to insult his exec utionerlest he make him angry.

One of the key battles within theA.M.A. was over whether health care is oris not a "right." Dr. Milford Rouse , thenpresident of the Associati on , told the1967 convention : "We are faced with theconcept o f health care as a right, rath erthan a pr ivilege." Dr. Rouse con tinued:

If American freedom should be­come weakened or non-existent,there would be no need to concernourselves with the progress ofmedi-

FEBRUA RY, 1971

cine. The strength of every facet ofAmerican life is dependent on thestrength of others. No one part ofour nation can succeed if the othersare failing. We can, therefore. con­centrate our attention on the singleobligation to protect the A mericanway of life. That way oflif e can bedescribed in a single word: capital­ism.

This sta tement brought on a fantasticpropagand a barrage fro m " Liberals"everywhere. The " Libera l" Chicago DailyNews laid dow n a typical respo nse:

It is unfortunate that the AMA ,by electing Dr. Rouse, has takenanoth er step backwards. reaffirmingits conservative and obstructionistpolicy when new ideas are urgentlyneeded to guarantee the delivery ofhigh-quality medical care to allA mericans. It is time for those whoseconscience is horrifi ed by such AMApolicies in the fi eld of social medi­cine to reaffirm that health care is aright which ought to be guaranteedto all by our society. and no t a privi­lege . . . .

The A.M.A. immediately became thetarget of New Left revolutio naries whoinvaded the nex t con vent ion denoun cingit as a meeting of the American MurderAssociat ion. Under pressure from avowedradicals, the A.M.A. collapsed on theissue . Its Plann ing Comm ittee declared :"The thesis that every hum an being has aright to all needed health services isdisarmingly simple and is now generallyaccepted." Since Dr. Rouse's term ex­pired , succeeding A.M.A. presidents havedeclared that medical care is a right. ..

The point of all th is flap over ideology isvery practi cal indeed. If health care is abirthright, then socia lized medicine is in­evitable - it is, aft er all, the job of the gov­ernment to guarantee rights. What thismeans is that every newborn child has an

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automatic lifetime healt h claim on thefruits of every ot he r American's labor. Italso means that instead of voluntarily ex­changing goods and services in the Ameri­can tradition, doctors may be ens laved toserve th is health right of citizens at thepoint of a government gun .

As soon as the A.M.A. adopted the ideathat medical care is a right and not a privi­lege, the Communists and other radica lswho had disrupted its recent conventionsstopped their demonst ratio ns. I attendedthe Boston convention in December of197 0 and fou nd it very quiet indeed. TheMarxists knew th ey had wo n.

The A.M.A. is no w co mmi tte d to Na­tional Health Insurance , altho ugh it cla imsto prefer its own socialized medic ine pro­gram called "Medicredit," ju st as it cameou t with th e ph on y Elde rca re alternat ivebefore Medicare was passed . It was Dr.Gera ld Dorman, a recent A.M.A. president,who gave away the strategy as follows:

I am not against having universalcoverage of health care but I don'tthink we are ready for it at thispo int . . . . I am not against thisidea of covering us all, we areworking for it, but give us a littletime to catch up.

In essence, the A.M.A. is asking thedoctor if he wo uld rat her be hung in themo rning or in th e afternoon, with a greenrope or a red one . American doctors haveon ly two choic es if they do n' t wan t to beliterally enslaved. Th ey can realize thatthey have been sold out by the o rganiza­tion they th ought would prot ect theirright s, and go to wo rk to fight both theKenne dy and th e Nixo n plans for socia l­ized medicine. Or, if th ey are unsuccessfulin stopping its passage, th ey can refuse topartic ipate. The fourteenth ame ndme nt tothe Consti tution prohi bits involuntaryservitude. Polit icians can pass laws, butthey can' t take out an appendix .

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Whe n Medicare was passed, man y doc­tors urged A.M.A. to come out forno n-pa rticipation - a proposal underwhich doctors would continue to practiseand perform medical services for all whosought them, but wou ld refuse to haveanything to do with the governmentprogram. The A.M.A. hierarchy killed thescheme. With the American Medical As­sociation on record as being opposed tonon-pa rticipation, agreeing that medicalcare is a right , and favoring NationalHealth Insurance, the doctor's fate maywell have been sealed by what he thinks ishis own orga nization.

But it is not only docto rs who have abig stake in the return of freedom tomedicine . The results of soc ialized medi­cine in the rest of the world ind icat econclusively that , und er regimen tation ,medical care deteriorates. And, as thecare gets worse the costs skyrocket.America's economy is already over­burdened with taxes, and Nat ional HealthInsurance might well prove the st raw thatbroke the camel's back - after all, Ted dyKennedy's $70 billion socia lized medicalpackage is quite a straw . You may becertain that Mr. Nixon's "economy" pro ­posa l will be more from the same bale.

My own view is that this thing can stillbe stopped . The so-called " health crisisfacing America" is almost who lly thecrea tion of about fifty men in the massmedia who have turned on the p rop a­ganda machine at the behest of Insiderspushing America ever Leftward. Bothdoctors and their patien ts must work toexpose this fraud or the he alth of genera­tions of Ameri can s will suffer as a result.Socialized medicin e is on the way , doc­tor. Either you help to shoot down thetrial balloon or we will all have to facethe conseque nces. What is absolutely cer­tain th is tim e is that yo u ca nno t dependon the big guns at the A.M.A. to shoot itdown for you. Their sights, appar ently,are aimed at the nape of your neck. _ -

AMERICAN OPINION