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America's Town Hall Meeting of the Air 37-12-23 - What System of Medical Care Should We Have
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America's Town Hall Meeting of the Air 37-12-23 - What System of Medical Care Should We Have
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Moderator/Host
Town meeting tonight Town Meeting Tonight Bring.
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Dr. Gilbert W. Hague
Your questions to the old Town Hall.
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Mr. George V. Denny, Jr.
What system of medical care should we have?
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Moderator/Host
Town Meeting Tonight.
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Town Hall Announcer/Assistant
What does the town meeting mean to you? Here is what two librarians have to say. The librarian of the Kansas City, Missouri Public Library writes us, I quote, america's Town Meeting of the Air is our most widely listened to educational broadcast. We have 15 branch libraries. If you have enough bibliographies to send us a supply for each topic, I am sure the branches would make good use of them. From the library in Martinez, California, the county librarian writes, I quote, we have set up a town meeting bookshelf using the recommended list of books and change.
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Dr. Arthur C. Christie
The books for different programs each week.
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Town Hall Announcer/Assistant
There are many people in our community who listen to the town Meeting and like to discuss it later. I am sure this will be a welcome service to our public. The Town hall is pleased to cooperate with America's libraries in making it possible for people to be better informed on problems affecting our national welfare. And now, may I present the Director of the Town Hall, New York and Founder and Director of America's Town Meeting of the air, Mr. George V. Denny, Jr. Mr. Denny.
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Mr. George V. Denny, Jr.
Good evening neighbors. On November 25th, when we discussed the subject Has Science advanced human happiness? Mr. Ralph Borsodi, one of our speakers, made a statement that milk, when pasteurized, loses its nutritive value. We received many comments that this was not correct. In fairness to all Sides, we ask for the opinion of New York City's Commissioner of Health, one of the country's leading authorities, on this question. Here is what Dr. John L. Rice, the Commissioner of Health of New York City, has to say. I quote, my attention has been called to a statement made at one of your town meetings to the effect that milk, when pasteurized, loses some of the important nutritive elements. I am amazed that anyone could make such a statement at this late date. Extensive research carried on for many years in many parts of the world has shown conclusively that pasteurization does not change the nutritive value of milk. The same amounts of protein, carbohydrates, fats and minerals are present. It is true that heating does diminish the vitamin C content of the milk, but this is readily supplied in other foods. In the case of infants who get pasteurized milk, the addition of a little orange juice or barley water has been recommended. The purpose of pasteurization is the killing of bacteria that produce disease. Since the adoption of this method, thousands of lives have been saved. It is to the pasteurization of milk, more than any other factor, that we owe the great reduction in the communicable diseases of childhood. The method of pasteurization was originally described by Pasteur, and this is one of the contributions which has caused him to be acclaimed one of the greatest benefactors of mankind. Thank you, Dr. Rice. I'm very glad to read that statement made by the Commissioner of Health for the city of New York. Now tonight we are going to discuss another subject, a subject in the field of science. How we are using science, a subject which not only concerns our minds, but our physical well being as well as the title, what system of medical Care should we have? This question has been the subject of controversy within the medical profession for some time and was recently the cause of a division of opinion in the American Medical Association. We bring you this evening three points of view on this question and are fortunate in having with us Dr. Arthur C. Christie, world famous X ray specialist and professor of radiology of George Washington University Medical College, who will speak in the favor of the system of private practice. Dr. Gilbert W. Hague of Worcester, Massachusetts, co author of the first bill ever introduced for statewide compulsory medical service, who will speak for what is commonly called socialized medicine, and Dr. Kingsley Roberts, medical director of the Bureau of Cooperative Medicine, who will offer the cooperative solution medical care. Now I take pleasure in presenting Our first speaker, Dr. Arthur C. Christie. Dr. Christie.
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Dr. Arthur C. Christie
Mr. Denny. Ladies and gentlemen, the question which we are attempting to answer here is of great social importance. In it is involved not only the progress of medical science and the welfare of the medical profession, but the people, but the health of the people as it is affected by the methods adopted for prevention of disease and care of the sick and injured. I am sure that my associates on this program wish with me that our discussion may result not simply in presentation of opposing views, but that candid statement of different viewpoints may promote understanding and bring to light a common ground upon which we may unite to wage battle against the common enemy, disease. It is my responsibility upon this program to try to present the views of the medical profession. I presume to do this not because I occupy any official position in organized medicine at the present time, but only because of wide and intimate contact with the profession. Throughout the United States. Following my service on the Committee on the Cost of Medical Care, there has been much misunderstanding concerning the attitude of the medical profession on social questions, and because of these misunderstandings many false issues have been debated. It seems necessary, therefore, at the outset of the discussion tonight, to try to define the position of the profession on the question of the socialization of medicine. The term socialization has two quite dissimilar meanings. In one sense, to socialize means very simply to render social to adapt to the needs of society. In the other sense, to socialize means to render socialistic to adopt the principles and methods of socialism. In the first sense, the socialization of medicine has been taking place gradually over a long period of time. There are many needs in modern society for the prevention of disease and the care of the sick which the individual physician cannot supply. The community or state must support a department of health whose duty it is to ensure a pure food and water supply, the prevention and care of contagious disease, the hospital and clinic care of the indigent sick, and the institutional care of the tuberculous and the insane. All of these and numerous other services are being provided at public expense, and such services will undoubtedly be expanded in order to adapt modern medical discoveries to the complex needs of modern society. There will undoubtedly be constant adjustments between the private practice of medicine and public health departments, as it becomes apparent that one or the other, or both together can best cope with specific problems as they arise. The ideal to be constantly sought as the harmonious cooperation of the public health service on the one hand, with private practice on the other. The medical profession is not only not opposed to socialization along these lines, but actively supports every measure directed to such ends. I believe that I correctly state the attitude of American physicians when I say that they believe in socialization of medicine when it is defined as the adaptation of medical facilities to the changing needs of society. It is their belief, however, that this adaptation is to be accomplished not by revolutionary methods, nor by changes in our social system which necessitate substitution of collectivism and authoritarianism for our present system of individual initiative under the control of law. With such a philosophy, what system of medical care should we have? The answer of the medical profession is the system we already have, with such changes as are necessary to better adapt it to the industrial society of our day. What has this system of medical care accomplished in the United States? It has resulted, first, in the development of medical education to the highest level ever reached in any country. Second, after a battle of more than 30 years by the American Medical association, almost single handed, the evils of patent medicines and quackery have been brought almost completely under control. Third, the profession, through research and experience, has brought to light almost innumerable new methods for the prevention, diagnosis and treatment of disease. And fourth, the medical profession is today from one end of this country to the other, giving a higher quality of medical care to the people. People than the world has ever before known. That changes are necessary in our present system in order that there may be continued progress, no one will deny. With regard to the nature of the changes, there is wide difference of opinion. The medical profession is at present advocating some very definite constructive measures. First, it recommends most earnestly and as a fundamental necessity, a change in the method of caring for the indigent, so that ultimately the entire community may assume at least two part of the burden which has heretofore been borne entirely by the medical profession. It has long been a tradition of the profession that every person, man, woman and child, regardless of economic or social condition, is entitled to medical care when he is sick or injured. In accordance with this tradition, the physician has always given free medical care not only to the indigent, who are dependent for their total support upon the community, but to the poor, who have only a bare subsistence ways to support themselves and their families. This is the only means provided by modern society for the medical care of the poor. If every community would accept the responsibility of taking care of its indigent sick at public expense, the problems of the medical care of the low and moderate income groups would immediately assume different proportions. Next, the profession recommends the adoption of systematic plans in every community to provide adequate medical care to each and every class of the population. This involves establishment of central admitting bureaus for hospitals and free clinics and the organization of nonprofit medical, dental service Bureaus operated by physicians and dentists through which patients of moderate means may arrange to pay their medical, dental and hospital bills in installments and through which the total charges may be adjusted to the patient's ability to pay. Third, the medical profession is giving support to the establishment of non profit group hospitalization plans in many communities. Why does the medical profession approve group hospitalization and disapprove the usual health insurance plan? The reasons are plain and hardly escapable when once stated. Group hospitalization is a plan in which a non profit corporation contracts with individuals in employed groups upon the monthly payment of a certain small sum to give to the individual a certain limited number of days hospitalization in a given year, the kind of accommodations and services to which he is entitled being definitely specified. The nonprofit corporation at the same time contracts with each hospital of the community to pay a certain specified sum per day for definitely specified accommodations and services. The important element in this arrangement which makes it sound financially and socially is the very definite and specified limitation upon the benefits to be received. So long as the limitations are respected, the plan is workable and sound. Contrast with this the usual health insurance plan in which a non profit corporation agrees to give to an individual for a certain specified monthly payment, medical care unlimited as to quantity and impossible of specification as to quality. It is this inherent impossibility to place limitations upon the amount and kind of service to be rendered which makes such plans unsound financially and which give rise to many of the evils growing out of them. If we are finally to adopt on a wide scale any type of health insurance in this country, there are certain facts established by European experience which should be known. No advantage can be gained by copying the mistakes of Europe. We need not experiment in this country with voluntary types of health insurance, because more than 50 years of European experience has proven that voluntary insurance always fails and is finally superseded by compulsory insurance. When failure is imminent or has overtaken a number of the voluntary groups, compulsory laws are passed and a great block of the population is compelled to participate in the plan. The important thing to remember is that all of the voluntary plans finally became compulsory insurance under state control. There have always been optimistic promises made in each country when the plans were before the voters. The voluntary insurance plans called group health associations and by various other names which are at this moment springing up in this country are repeating these old and discredited promises again. We are being told that they will so improve the health of their subscribers, especially through periodic examinations, as to reduce the mortality and sickness rate among them. It can Be confidently predicted from experience that the death rate will remain unaffected and that the days lost from sickness will be greater in the insured group than in a like group of uninsured persons. If we are finally to have insurance medicine in this country, Let us not delude ourselves into experimenting with the voluntary or cooperative type. Let us adopt the only kind that can survive, namely compulsory insurance. Let us go into it with our eyes open, remembering that it necessitates a wage and payroll tax, a government subsidy with a high degree of governmental control to make it successful. Let us recognize the fact that there must be in a country like ours much political control and manipulation and establishment of an elaborate bureaucracy for its administration. The medical profession is a small body of men, only about 150,000 in a population of 125 million people. The profession must adjust itself to whatever social system the 125 millions decide to adopt. We are, however, because of our special education and training, in a strategic position to judge of the effects of proposed methods of medical care. It is our conviction that the present system is the one best adapted to the liberal philosophy of democracy and that it can be and is being adjusted to every need of the people without the evils of health insurance or state medicine.
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Mr. George V. Denny, Jr.
Thank you, Dr. Christie. Now we're going to hear a slightly different view from Dr. Gilbert W. Hague of Worcester, Massachusetts, who will give us his version of socialized medicine. Dr. Haig.
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Dr. Gilbert W. Hague
Even in this democratic country, the socialization of medicine has already progressed a long way. Unlike its development in foreign nations, where it sprang from the curative phase of medicine, Here it has grown from the preventive phase, public health, from sanitation and quarantine of contagion. It has waxed step by step with the applicability of the discoveries of the biological sciences. Today there is an acknowledged need of extending its scope through public sanatoria for chronic arthritis and the further expansion of its laboratory facilities. On account of the waning of private charity incident to the present general economic changes, the government will soon be obliged to assume, either directly or indirectly, the financial responsibility for the care of the sizable class of the indigent. This rational trend in the evolution of state medicine in America has been so satisfactory as to meet the approval of both laymen and doctors. In fact, one of the two unanimous conclusions to be drawn from the reports of the various commissions upon the problem of improving medical care during the last decade Is that the socialization of medicine shall proceed as in the past by increasing the activities of the existing departments of health. But a very important fact has escaped due consideration, namely, that the added functions of public health may impair its future success if it is not suitably organized for further growth. At present, in most common wealth it is composed of independent and loosely coordinated parts corresponding to the political division. Each one of its separate units of varying professional standards offers a standing invitation to the dishonest among politicians. Mindful of the baneful effects of politics upon the public schools, and fearful of such meddling with medical practice under state control, thinking persons insist that doctors be granted sole charge of any new system. Otherwise the quality of the service rendered will inevitably suffer for none but physicians are capable of determining and maintaining the highest type of medical practice in America. The quality of the service must not be compromised, as in Europe, for mere quantity. This prerequisite for the reformation of medicine is the second outstanding premise to be gleaned from the voluminous literature upon this controversial subject. Now there is but one known kind of medical organization in which the members are entrusted with full control. That is the semi military, such as the Medical Corps, the Army and the Navy, and the United States Public Health Service. In them, the doctors have the entire responsibility of management. Such power can stand safely be granted because the members forego the profits of private practice and violate their trusts only at the risk of their commissions. Merely the Surgeon General, invariably chosen from the highest ranks, has any political connection. No officer is subject to political interference in the performance of his duties or in the pursuit of his career. This semi military form is a businesslike organization in contrast to a political organization which offers merely a job. These medical bodies have actually fostered a superior quality of service. The personnel rise in grade in accordance with their ability and experience, because merit is what really counts and not include since 1906 they have been automatically admitted to fellowship in the American Medical Association. Relieved of monetary distractions, their offices are more prone than private positions to respect the healing powers of nature and to heed their own limitations. Having a primary interest in health, they are encouraged to put prevention before cure and are never discouraged from doing otherwise. The Medical Corps, the Army and Navy, in spite of the sudden influx of civilians untrained in cooperative medicine and anxious to resume their dwindling private practices, met with glory, the supreme test of the World war, these services rightly stretch stress prevention. This means more than guarding against the external causes of diseases. It means, in addition, promptly removing the internal causes. For this, the positive essential is early diagnosis. This, however, may be possible only while the symptoms seem too trivial to warrant the cost of a medical consultation. Industrial medicine has definitely proved the value of free and ready treatment for the employees of the larger corporation, for it pays in dollars and cents for personal or professional reasons. Some physicians many times, and many physicians sometimes are disinclined to make sufficient effort or to take enough time to diagnose diseases early. They evidently lack the necessary discipline and stimulus inherent in a semi military organization. Whatever experiments may be made in the field of private practice, there is no excuse for further delay in the rational reorganization of the numerous politically controlled health departments. On the contrary, there is urgent demand for immediate action. For the longer it is postponed, the less easily can it be accomplished because of the selfish interests of office holders. Of all the many governmental agencies crying for reconstruction upon a business like basis, this is the most pressing. Here then is a simple method of attacking this problem of the further south socialization of medicine. It would require the appointment of a legislative commission composed of the commission of public health as chairman, with representatives from each of the army, navy and federal public health service, the state medical society, industry, labor, the bar, and possibly others. Their task would be to draft the necessary bill to fit the present disorganized medical divisions into a unified system patterned upon the general structure of the three services mentioned, together with such special features of each as would provide the best possible organization an appeal to the finest type of medical men. It might must be elastic enough to permit further expansion in response to the needs and the demands of the people. In conclusion, under this concrete plan of reorganization, the socialization of medicine in America can safely and soundly continue its present course at a pace that set by the citizens of each commonwealth, however far or fast it may develop towards a universal system of public medicine. Under expert direction, the standards of American medicine will be securely upheld. The main support of these will come from the concerted emphasis upon preventive medicine, about which more than 300 years ago, in his advancement of learning, Francis Bacon. This is a new part of medicine and deficient, though the most noble of all. For if it may be supplied, medicine will not then be wholly versed in sordid cures, nor physicians be honored only for necessity, but as dispensers of the greatest earthly happiness that could well be conferred upon mortals.
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Mr. George V. Denny, Jr.
Thank you, Dr. Hay. And now we're going to hear from Dr. Kingsley Roberts of New York, who will give his views on Cooperative Medicine.
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Moderator/Host
Dr. Roberts. Ladies and gentlemen, you have just heard from what I would consider to be two of the greatest optimists in the world. On one hand we have an advocate of the continuance of the present type of medical practice who Believe that's all right. On the other hand, you've heard from a doctor who, as a result of his experience in the army, believes in the expansion of that system. I will try and tell you as much as I can about cooperative medicine. Students of the problem know that to extend medical services beyond their present limits, the insurance principle must be applied. Cooperative medicine provides this on a voluntary insurance basis and is nothing more or less than the application of cooperative control to voluntary health associations. Why do we need cooperative medicine? I have performed your figure that answers that question. And that figure is this. In the state of California, according to studies made by the California Medical society society, during one year, 44 people out of every 100 requiring medical care did not get it and did not get it because they were afraid that they could not pay the bill. This clearly demonstrates the need for the expansion of medical service to a group that can pay for it. You know that the budget of the average American family at present does not and cannot make provision for the unpredictable cost of medical care. The reason is that no one knows when disease, simple or serious, will enter the home and throw life and finances into a chaos. In substantiation of that point, I would like to cite the fact that 28% of all of the personal loans made in the United States were made to pay medical bills as an antidote. The practice of cooperative medicine is based upon four fundamental points. The first is group medical practice. By that I mean the organization of doctors into staffs in which each one is practicing that part of medicine for which he is best fitted or trained, and on a sane and sound economic basis. Time marches on, and medical science marches step for step with time. Group medical practice is the most efficient method of making available to the people who need them most the benefits of that progress. Formerly, the family doctor with his little black back in his horse and buggy was the only source to which a man and his family could turn for medical aid. The family doctor in his time saved many lives and gave service and kindness and care. He performed splendid deeds in the pursuit of his duties. But the country doctor of past years could not. And the isolated private practitioner working alone in the city office of today cannot give complete, thorough diagnosis and care. To me this statement is so obvious as to be almost unnecessary. The former was excusable. The latter is not defensible, either economically or scientifically. Because the rapidity of medical progress prevents many doctors from giving adequate attention to this progress and at the same time efficiently maintaining their private practice. Then it is, to me logical to suppose That a system under which each doctor is practicing that part of medical science for which he is best fitted will bring to an association of patients more adequate medical care under the present conditions. When an individual is taken ill, unless he is fortunate enough to have a very broad minded personal physician, he is utterly confused by the necessity of making a choice from the various specialties which might be indicated by his illness. And it is human nature to want a specialist. However, if he can go to a group of physicians, that confusion is replaced by assurance. The second point in cooperative medicine is preventive medicine. I wish that there were time to tell you all I should like to about that phase of the work. It gives the individual the opportunity of consulting with his doctor at any time without additional cost to assure himself of the protection of early treatment and health conserving methods. In short, we all know it is easier and cheaper to keep well than to get well. The cooperators cannot hope to get get good medical care cheap, but they can materially increase the purchasing power of the medical dollar. Preventive medicine and group practice will assist this by reducing the incidence and severity of disease. And don't let anybody tell you otherwise. The third point. Periodic payments for medical care. By that I mean that an individual may receive medical care from a competent source by periodically paying fixed sums. Under these conditions that all important first visit is already paid for. Hence he consults his doctor earlier. The fourth principle is cooperative control. The right of the individual to determine what he shall pay for and how he shall pay for it. I don't have to tell you that cooperation is the very essence of democracy. It is a principle upon which our government functions. Cooperative control of collective medicine gives the individual the opportunity to select the people who shall conduct the affairs of his organization, its business policies and the performance of its duties. As a medical man, I don't need to emphasize the fact that this of course, applies to the fiscal administration and not to the practice of medicine. There you have the structure of cooperative medicine based on the four fundamental group medical practice, the most efficient method of diagnosing and treating disease, preventive medicine, the opportunity to forestall disease periodic payments, the method for paying for medical care and cooperative control, whereby the individual has a choice and assumes his proper place in the government of an organization of which he is an integral part. We need cooperative medicine because it is better medicine for more people. It is better because it operates on the theory of group problem practice, wherein the individual has made available to him the full knowledge of all the branches of medicine in their specialized form. The individual who Subscribes to cooperative medicine receives complete treatment and perhaps even more important, continued treatment. I said a moment ago that 44 out of 100 people in the state of California who needed medical care did not get it. Of the 56 who did get it, a majority fail to receive continued medical treatment for financial reasons. Cooperative medicine means better medicine for more people. Better medicine practiced by doctors working under better regulated conditions. Better medicine practiced by doctors, each of whom is a member of an organized staff. Better medicine practiced by doctors helped by the best diagnostic facilities and in a position to readily utilize the increasingly necessary consultation. Better medicine practiced by doctors who know that they are going to have time off for study and research on pay. Better medicine practiced by doctors who are kept abreast of their times by a sound and easy working basis with their contemporaries. We doctors want cooperative medicine because it will increase the demand for medical service. More doctors will be needed. The trouble with medicine is not the fact that there are too many physicians, but the fact that there are too few patients able to pay for adequate medical care. Cooperative health associations provide individuals in both rural and urban areas with opportunities to get adequate medical care. In Elk City, Oklahoma, an experiment is now in process which shows that even on the edge of the Dust Bowl, 2,500 individuals or families can group together and build for themselves a hospital and a medical staff, and all under a system which does not add to the tax burden and does not involve government control. In summation, then, cooperative medicine brings medicine to more people because it is based on those four fundamentals. It gives a man and his family the opportunity to avail themselves of more competent medical services by groups. The principles of American democracy include that of the right of the consumer to purchase medical service on any or any other service in any way that they can see fit. And the American doctor must not be denied the right by the American Medical association to enter into that experimentation if he so desires. And finally, cooperative medicine is the only economically sound arrangement by which the medical profession can practice one of its most important functions, that of preventive medicine, and be paid for it.
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Town Hall Announcer/Assistant
We pause for station identification.
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Dr. Arthur C. Christie
WJZ, New York.
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Mr. George V. Denny, Jr.
Back in town hall, America's town meeting of the air, discussing the question, what system of medical care should we have? We've just heard three interesting views presented on this question. And now we are ready for the question period. Our question period is going to be divided into two, two parts tonight. One here in New York and the other from a group out in Detroit. First, we're going to hear from the New York audience here in Town hall questions. Please rise and state the name of the person to whom your question is directed.
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Moderator/Host
Amanda, in the back.
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Mr. George V. Denny, Jr.
Please rise. Yes, all right, sir.
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Dr. Arthur C. Christie
Dr. Kingsley, is it?
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Mr. George V. Denny, Jr.
Dr. Roberts. Dr. Roberts. Yes.
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Town Hall Announcer/Assistant
How would you provide medical care for expectant mothers who while not actually sick, nevertheless have need for competent medical care before and during childbirth but cannot afford it?
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Moderator/Host
Dr. Robert.
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Mr. George V. Denny, Jr.
How would you provide for expectant mothers under a cooperative system of medic.
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Moderator/Host
Join. They would have joined a year before. A cooperative health association. Thank you.
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Audience Member
Statistics show that out of 20 ailing people, one consults the physicians, one that.
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Dr. Arthur C. Christie
Consults the pharmacist, three available.
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Mr. George V. Denny, Jr.
Excuse me, Would you repeat that louder, please, in that direction, please.
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Audience Member
Statistics show that out of 20 ailing people, one consult the physician, one the pharmacist, three avail themselves of hospital facilities, including free dispensaries, clinics and so forth. The balance of 15 out of 20 ailing people medicate themselves with cheap or expensive patent medicines or household remedies. Would Dr. Christie trust the millionaire patent medicine industry, insecure as it is, or a free access to the doctor's office, the dental office, the pharmacy or the hospital as under a plan of socialized medicine as a means of promoting preventative medicine? The medical world aspires for.
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Mr. George V. Denny, Jr.
Christie, that that's correct. Will you comment on the question?
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Dr. Arthur C. Christie
I think I have no comment to make. It's obvious that preventive medicine is not to be carried out by any such people as the gentleman has mentioned.
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Mr. George V. Denny, Jr.
Next question.
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Moderator/Host
Yes, Dr. Christie.
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Mr. George V. Denny, Jr.
Dr. Christie.
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Moderator/Host
Did I hear you say.
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Dr. Arthur C. Christie
That the patent medicine was under control.
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Moderator/Host
Already by the American Medical Association?
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Mr. George V. Denny, Jr.
Have you heard anything? That's your question?
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Dr. Arthur C. Christie
Yes. The. During 30 years, the patent medicines of the evil import have been gotten practically under control by the American Medical Association's activities.
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Mr. George V. Denny, Jr.
Thank you. Dr. Hay, here's a written question addressed to you.
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Moderator/Host
You step up here, please.
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Mr. George V. Denny, Jr.
What chance will a young doctor have in the world of socialized medicine to make a career for himself? The question hasn't stumped you, has it, Dr. Haig?
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Dr. Gilbert W. Hague
He'll have the same chance to make a living under socialization that a schoolteacher has to make a living.
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Mr. George V. Denny, Jr.
All right, question back. Dr. Cribbing. How, under a system of private medical practice can you provide a perfect distribution.
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Moderator/Host
Of physicians according to population?
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Mr. George V. Denny, Jr.
I understand. Now we've got it. Yes.
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Dr. Arthur C. Christie
How can we provide, under the system of medical practice, a perfect distribution of physicians throughout the entire population? It cannot be done under any system of practice. It's necessary in the remote areas that are unsettled to provide physicians by government subsidy and and that has to be done. And all physicians agree to that, that it should be done.
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Mr. George V. Denny, Jr.
Let's see. I think Dr. Haig better speak to that question, too. Dr. Haig, what do you think about that? The answer Dr. Christie has given to that question.
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Dr. Gilbert W. Hague
Well, that can be controlled through the public health department, just as they control the distribution of nurses to rural community.
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Mr. George V. Denny, Jr.
Little disagreement here. Dr. Roberts, here's a question, a written question for you. What is the difference between your plan and any other voluntary health insurance plan?
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Moderator/Host
It's under cooperative control. Meaning by that that the members have a say in the organization and running of the business.
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Mr. George V. Denny, Jr.
Here's another one for you. Don't you think the English system of health insurance is good?
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Moderator/Host
I do not, because the proper application of the permitted medical side has not been made.
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Mr. George V. Denny, Jr.
Thank you, sir. The young man there in the back.
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Moderator/Host
Yes, Dr. Christie. Dr. Christie, the medicos, that is, the doctors, tell us that in order to have health, we must have food and rest and sunshine.
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Mr. George V. Denny, Jr.
In view of the fact that according.
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Moderator/Host
To the president, a fourth of the.
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Mr. George V. Denny, Jr.
Population lacks all of these items, how.
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Moderator/Host
Can there be good health unless the.
- [42:16]
Mr. George V. Denny, Jr.
Private ownership of the means of wealth reduction are abolished and socialism not?
- [42:25]
Dr. Arthur C. Christie
Certainly the medical profession has preached that for a long time that the economic problems of medicine are closely associated with the total economic situation. Situation in this country. And that until the worker of the country gets the proper fruits of his labors, it's going to be impossible for him to get proper medical care except through the way that the doctors give it now, and that is by giving him all the time the care that he needs.
- [42:56]
Moderator/Host
Dr. Christie, how about you? Medical practice, which is largely in the field of experiment and discovery, were standardized through a system of socialized medicine, would it not be possible to actually impair the health of the people, having in mind various serums which have been carried out on millions of people and later rejected?
- [43:24]
Dr. Arthur C. Christie
I think there's no doubt that the quality of medical care under any system of socialized medicine has been definitely proven to be poorer under the. Under socialization than it is under the general practice that we have at the present time.
- [43:40]
Mr. George V. Denny, Jr.
Thank you, Dr. Fisker. Let's have another opinion on that from Dr. Haig. Dr. Haig, come on to your defense here. Is that right or.
- [43:47]
Dr. Gilbert W. Hague
That is right, because we have not the proper organization. Political instead of businesslike.
- [43:58]
Mr. George V. Denny, Jr.
Young man there.
- [43:59]
Dr. Gilbert W. Hague
It seems to me that.
- [44:03]
Mr. George V. Denny, Jr.
Yes, I'd like to know what Dr.
- [44:04]
Dr. Arthur C. Christie
Haig thinks of the possible socialization of.
- [44:07]
Moderator/Host
Medicine in Russia at present.
- [44:10]
Mr. George V. Denny, Jr.
Oh, I think we better confine our Discussion to the United States. Next question. Question from Dr. Robertson. Dr. Robinson.
- [44:20]
Dr. Gilbert W. Hague
Do you believe it is.
- [44:22]
Audience Member
Possible to have socialized medicine without the.
- [44:25]
Moderator/Host
Demoralization of the medical profession, without the.
- [44:28]
Mr. George V. Denny, Jr.
Building up of a top heavy bureaucracy.
- [44:31]
Moderator/Host
And prohibitive costs to the taxpayer? I cannot discuss the question of socialized medicine because I don't know what you mean by it.
- [44:39]
Mr. George V. Denny, Jr.
If you will define it, I'd be.
- [44:41]
Moderator/Host
Very glad to answer the question.
- [44:42]
Mr. George V. Denny, Jr.
I think your question should be addressed to Dr. Hague. Dr. Haig, how about bureaucracy and heavy overhead organization in the administration of socialized medicine? I think that's the purport of the gentleman's question.
- [44:57]
Dr. Gilbert W. Hague
The difference between the two is state medicine, properly organized, is run by the doctors who accept the cell run. Health insurance is run by doctors who do not accept a salary who enjoy the profits. Therefore, health insurance contains all the disadvantages of cheap private practice.
- [45:36]
Mr. George V. Denny, Jr.
Thank you, sir. Let's take this young lady here.
- [45:39]
Audience Member
Yes, Dr. Hayes. Dr. Hayes, under a socialized setup wouldn't intend to eliminate the medicine careerist. And wouldn't that be a good idea?
- [45:53]
Mr. George V. Denny, Jr.
How about eliminating the medical careerist? Is that a good idea or not?
- [46:00]
Dr. Gilbert W. Hague
I think that a career is preferable to a job. A career stimulates earnestness. It maintains high quality. A job encourages favoritism to those politicians who control the job.
- [46:26]
Mr. George V. Denny, Jr.
Thank you. Rock the balcony. The young lady in the balcony. Yes. Yes, Dr. Christopher.
- [46:38]
Audience Member
Which the medical association approves. How will Mr. Average Layman pay for any medical care after the specific time has been used? And also the overhead and incidentals such as doctor's expenses and surgical dressings, which is not included in the limited plan.
- [46:57]
Mr. George V. Denny, Jr.
Of group insurance.
- [47:02]
Moderator/Host
Doctor?
- [47:03]
Dr. Arthur C. Christie
Well, I don't know whether I ought to answer that or not. That's the group insurance, of course, I'm not in favor of except so far as it applies to group hospitalization. That is all. But under group hospitalization, it does provide for the dressings and all of the things that are necessary and hospitality care of the patient, but does not provide for medical care which is an unlimited service which cannot, as I believe, come rightly under insurance.
- [47:32]
Mr. George V. Denny, Jr.
Dr. Roberts, do you want to comment on that or are you satisfied with that answer?
- [47:35]
Moderator/Host
Well, I'm not satisfied with it because I don't agree with Dr. Christie. It can come under insurance. For every one person who's interested in hospitalization insurance, there are 10 who are interested in knowing how to pay all their medical bills. Bill.
- [47:52]
Mr. George V. Denny, Jr.
May I ask, Dr. Robert, who makes a profit?
- [47:56]
Moderator/Host
Who makes a profit on the Cooperative Health Association? Nobody. Nobody.
- [48:02]
Mr. George V. Denny, Jr.
Nobody makes the profit A young man like that. Dr. Hayes. Dr. Hayes. Wouldn't it be better instead of first changing the medical system to change our democratic society?
- [48:13]
Dr. Arthur C. Christie
Society in which there are so many.
- [48:20]
Dr. Gilbert W. Hague
As long as the majority of people possess some wealth, naturally democracy will survive.
- [48:32]
Mr. George V. Denny, Jr.
It's just about impossible to discuss these questions without running up against the economic problem, isn't it? Now, as we told you last week, there are a great many YMCAs throughout the country who form town meeting discussion groups. Tonight, through the miracle of radio, we've arranged with one of these groups, the Detroit YMCA Town Meeting Discussion Club, to participate from Detroit in this meeting by asking questions of our speakers. The question has often been asked that raised that link. Listeners rarely have an opportunity to participate. Now, through the medium of radio, time and space have been annihilated so that our listeners can ask questions from any part of the country. Under the chairmanship of Mr. George G. Wright, some 50 members of the Detroit YMCA town meeting discussion Club are ready to question our speakers here in Town Hall. Are you ready with your questions?
- [49:33]
Mr. George G. Wright
Yes, Mr. Denny. As usual, our Western Branch YMCA town hall discussion Club is gathered around the radio listening to your speakers and discussions. On other Thursdays our questions are discussed and are sometimes answered within our own group. But tonight we welcome the chance to put our questions directly to your speakers in New York. May I first, however, on behalf of our club, thank the America's Town Meeting of the air for this opportunity.
- [50:01]
Dr. Arthur C. Christie
One of the purposes of the Young.
- [50:02]
Mr. George G. Wright
Men's Christian association is to educate its members in public affairs. Unless and until the vast majority of our citizens are intelligently informed on such questions as the one being raised tonight, we don't believe that our democratic form of government is secure. Thank you, Mr. Denny. And now we have our first question.
- [50:24]
Mr. George V. Denny, Jr.
All right, sir.
- [50:25]
Moderator/Host
Dr. Arthur W. Hague.
- [50:27]
Dr. Arthur C. Christie
Dr. Haig, is there not a danger that the making of medicinal services too.
- [50:33]
Moderator/Host
Easy to obtain will develop a community mind or habit of sick mindedness?
- [50:40]
Mr. George V. Denny, Jr.
Dr. Haig, would your system develop a habit of sick mindedness?
- [50:45]
Dr. Gilbert W. Hague
A feature of my system was would be complete health records which would furnish material enough on which a correct diagnosis could be made. Many patients who are neurotic or appear to be malingerers are suffering from sociological problems. They need a after careful medical examination to be referred to the social service worker, the psychiatrist, the clergyman, the lawyer, even the police.
- [51:29]
Mr. George V. Denny, Jr.
Thank you, Dr. Hayes. Are we ready for your next question, Mr. Wright?
- [51:34]
Moderator/Host
Dr. Roberts.
- [51:35]
Mr. George V. Denny, Jr.
Dr. Roberts, how can cooperative medical service be made to provide for the families of low income, irregularly employed workers such as the automobile Workers of Detroit who are not poor enough to claim free.
- [51:47]
Moderator/Host
Service from the state nor able to pay for adequate service out of their wages.
- [51:52]
Mr. George V. Denny, Jr.
Dr. Roberts, he wants to know how is it possible for your, under your system for workers irregularly employed to benefit by a system of cooperative medicine such as you've described?
- [52:08]
Moderator/Host
Unfortunately, all voluntary plans have their limitations. There are times at which voluntary plans will have to be assisted by some type of government subsidy. I prefer that to government control.
- [52:22]
Mr. George V. Denny, Jr.
Thank you, Dr. Roberts. Ready again, Mr. Wright?
- [52:26]
Dr. Arthur C. Christie
Dr. Hayes. Dr. Hayes, what assurance have I that I would receive the same attention under socialized medicine that I would receive from my own Personal physician?
- [52:37]
Dr. Gilbert W. Hague
Dr. Haig, if you are competent to pick out a capable, honest physician, perhaps you could find no better source of treatment. But the average man today, under the complexities of our civilization in our crowded cities especially, is not so competent.
- [53:06]
Moderator/Host
I wonder.
- [53:07]
Mr. George V. Denny, Jr.
I wonder if Dr. Christie would like to comment on that same question. Dr. Christie, could you comment on the gentleman's question from Detroit?
- [53:18]
Dr. Arthur C. Christie
What was the question?
- [53:19]
Mr. George V. Denny, Jr.
Will you repeat the question from Detroit, please?
- [53:23]
Dr. Arthur C. Christie
What assurance have I that I would receive the same attention under socialized medicine that I would receive from my own personal physician? It has been my experience a long time in the army to very greatly favor the service that is given by army physicians, just as Dr. Hague has pressed them tonight. I believe, however, that that cannot be extended to the private practice of medicine and that it would be almost impossible for anyone to be assured of the personal relationship under that type of practice that you can get in private practice.
- [54:08]
Mr. George V. Denny, Jr.
Thank you, Dr. Christie. Ready for your next question, Mr. Wright?
- [54:11]
Moderator/Host
Dr. Roberts.
- [54:12]
Mr. George V. Denny, Jr.
Dr. Roberts, your opinion.
- [54:14]
Moderator/Host
Just what is the difference of social obligation of the state for the health of its citizens as over against the education of its citizens?
- [54:23]
Mr. George V. Denny, Jr.
Dr. Roberts?
- [54:25]
Moderator/Host
None particularly.
- [54:27]
Mr. George V. Denny, Jr.
No difference. All right, that's Dr. Roberts. Answer your next question, Mr. Wright.
- [54:34]
Moderator/Host
Dr. Roberts, do you feel that the type of literature released by the larger insurance company companies regarding methods of prevention fit in with the cooperative health program?
- [54:46]
Mr. George V. Denny, Jr.
Dr. Roberts, you get that question?
- [54:47]
Moderator/Host
No, I get the last part of it.
- [54:49]
Mr. George V. Denny, Jr.
Does the literature released by the large insurance companies, is it compatible with the kind of plan that you've advanced? I think that's the question.
- [54:58]
Moderator/Host
No, no. Because of the reason that insurance companies or health insurance companies organized for profit must of necessity add to the cost premiums. Profit premiums.
- [55:10]
Mr. George V. Denny, Jr.
Does that answer your question in Detroit?
- [55:13]
Moderator/Host
Yes, it does. Thanks.
- [55:14]
Mr. George V. Denny, Jr.
Next question.
- [55:17]
Dr. Arthur C. Christie
Question of Dr. Hague. Dr. Hague, is there evidence that socialized.
- [55:22]
Moderator/Host
Medicine tends to level up the efficiency.
- [55:25]
Dr. Arthur C. Christie
Of medical service and encourage the personal initiative of medical Men in research.
- [55:32]
Dr. Gilbert W. Hague
If socialized medicine is founded on a business like basis corresponding to our largest corporations in industry, in philanthropy, I should say no, because it contains the stimulus to effort and offers the reward of effort and encourages a man to develop himself and pursue a career.
- [56:08]
Mr. George V. Denny, Jr.
Next question. Mr. Wright in Detroit.
- [56:11]
Moderator/Host
Dr. Christie, would it be a good.
- [56:13]
Mr. George V. Denny, Jr.
Idea to use doctors primarily as teachers.
- [56:17]
Moderator/Host
And train people to pay for counsel and advice on Keeping well?
- [56:22]
Mr. George V. Denny, Jr.
Dr. Christie?
- [56:23]
Dr. Arthur C. Christie
Yes, I think wherever it is possible, that ought to be done. But certainly we're a long ways yet from the development of society where people are willing yet to do that to pay to be kept well instead of to pay the doctor after they are sick. Certainly that ought to be an ideal at which we should aim that the people may be educated to the point where they will consult the physician in order to be kept well instead of after they become sick.
- [56:54]
Mr. George V. Denny, Jr.
Thank you, Dr. Christie. Next question.
- [56:57]
Dr. Arthur C. Christie
Dr. Christy.
- [56:58]
Moderator/Host
Dr. Christy, what is being done at the present time to give adequate medical care to those rural communities where doctors are a scarcity as compared to the great number of doctors who now locate in the large urban center?
- [57:13]
Dr. Arthur C. Christie
Well, not very much. Not nearly enough. It's very important that those rural areas should be taken care of where there are not enough doctors. And as I said before, it's going to be necessary to subsidize such areas through the states or even through the federal government. That is an economic problem that goes right down into other areas of the economics of the people as well as being a problem of medicine.
- [57:47]
Mr. George V. Denny, Jr.
You're not a question, Mr. Wright.
- [57:49]
Mr. George G. Wright
I would like to ask one myself. Now I've given other people a chance. Dr. Roberts, how has it been proved that socialization of medicine is always a failure in the sense that it reduces the effectiveness of treatment?
- [58:05]
Moderator/Host
Dr. Roberts, it has not been so proven. If you think it has, study the experiment in Elk City, Oklahoma.
- [58:15]
Mr. George V. Denny, Jr.
Another question from your group, Mr. Wright.
- [58:17]
Mr. George G. Wright
I believe we have one more.
- [58:20]
Moderator/Host
What type of educational program?
- [58:21]
Mr. George V. Denny, Jr.
To whom is this question, please?
- [58:23]
Moderator/Host
Dr. Christie? Dr. Christie, what type of educational program does the American Medical association follow at the present time to aid the public and keeping well?
- [58:34]
Dr. Arthur C. Christie
Well, it follows a very wide system of trying to educate the people through a journal, for instance, that is very widely circulated, Hygeia, through weekly broadcasts over a national broadcasting system. It also works through many different medical societies throughout the country in trying to educate different communities. It certainly is pursuing a very good course in the efforts to educate people along the lines of keeping well.
- [59:08]
Mr. George V. Denny, Jr.
Thank you, Dr. Christie. And thank you very much, Mr. Wright. And all our Friends out in Detroit for your splendid cooperation and thank you, Mr. Denny. I wish we could stretch the clock, but our time is up, and we'll have to turn this meeting over to the individual groups throughout the country and our listeners in their homes, wherever they may be. I think you'll agree that this has been not only an interesting but an informative discussion. As I've said many times before, we do not use the town meeting for the purpose of debate, but rather to present conflicting views on a given subject so that you can hear all sides and draw your own conclusions. Before Mr. Clay tells you what we're going to have for next week's program, I want to wish every, every one of you, our listeners, on behalf of the town hall and the national broadcasting company, a very merry Christmas. Mr. Cleaning.
- [59:59]
Town Hall Announcer/Assistant
Next week at this same time, our subject will be what will Japanese victory in China mean to America? Dr. Charles C. Batchelor, former chief of the far eastern division of the United States department of Commerce, and Mr. Upton Close, noted writer and lecturer on Chinese affairs, will be our speakers. The proceedings of each broadcast are prepared weekly in magazine form by the Columbia university press under the title bulletin of America's Town meeting of the air. If you wish copies of tonight's broadcast only, send your name and address, enclosing $0.10 to cover the cost of printing and mailing to The Town Hall, 123 W 43rd St, New York City. Or if you want copies of the entire series of 22 broadcasts sent to you each week, enclose $2 and send to the same address, the Town Hall, 123 West 43rd Street, New York.
- [61:09]
Moderator/Host
What will Japanese victory in China mean to America?
- [61:18]
Town Hall Announcer/Assistant
This is the national broadcasting Company.