(continued from page 25)
enough to seek poor care, they deserved it.9
thus cover everybody, by either private or government financing.
At this same time, the rise of industrial corporations in this
country shifted the balance of power from the professional. From
the Journal of the American Medical Association, 1902: “Members
of the profession are constantly humiliated and insulted by wealthy
corporations, state, county and city-officials.”10 Also sounds familiar,
doesn’t it? Once again, we have a large number of medical systems
with a strong corporate influence for you to enter, when most of
you leave the academic world.
In the late fifties, in a struggle between private insurers who sold
health insurance in risk-specific groups as opposed to the Blue Cross
plans, which spread it across all of society, a category of high-risk,
high premium groups was created. Society-wide rates could not
compete. Thus the disabled and the elderly began to “fall through
the cracks” and the need for Medicare and Medicaid was born.6
After this for 15 years, we had a system providing access for a large
segment of the population paid for mostly by corporations and the
government in that period from 1966 to 1981.
The entrepreneurial thrust into medicine was born in this same
time of relative plenty in the system by the appearance of numerous
investor-owned companies.
And finally, cost entered the system by 1980 when inflation in the
whole economy, social pressures to pay better wages in the hospital
industry, technological advances, and utilization had propelled
health care costs from 3 percent of the Gross National Product in
1930 to 12 percent in 1982.
Corporate CEOs, faced with bottom line considerations, would
start to tamper with benefits. A host of new ideas in delivery were
adopted quickly where they had lain fallow for a number of years
--- HMOs, PPOs, and IPAs.
Woody Allen once was asked if he believed in a Supreme Being.
He answered that he believed in a Supreme Intellect which pervades
the entire universe except for, say, parts of New Jersey.
In New Jersey, we had a new idea, the DRG, which was quickly
adopted for the whole country for Medicare patients. Why not pay
a lump sum and let the hospital and the physician decide about
utilization?
At the same time, poured into the cost mix was the liability issue.
In what one author has termed, “The Bhopalization of U.S. Tort Law,”
our fellow professionals, the attorneys, have become so innovative
and creative that they match our own achievements, all of which
may be more than people can afford.7
As a result, we have an increasing cost problem for medical
professionals and products. As I see it, we’re in a remarkably similar situation to about 100 years ago in this country when we had
practitioners on every street corner and in every hamlet. Medicine
had more a competitive rather than corporate image. There were the
Eclectic