A Plan of Prevention


“What do you know about Ameriplan, Harry?”  The voice of S.Q. Lapius was confidential.  Why did he pick just that moment to interrupt?  When my mind was unburdened, and I wasn’t concentrating on anything in particular, Lapius was usually silent.  But the moment I became involved, as at this moment, in replaying the chess game in the Daily Times, Lapius was sure to derail my train of thought.  It was uncanny.


“The Ameriplan?”  I said without looking up from the board.  “You mean a hotel at which breakfast is included in the price of the room?”


“That’s the American plan.  Ameriplan is different.  Are you interested?”


“For days, Simon, you have suggested that if I studied the masters’ games in the papers I might provide better competition for you in chess.  I am doing just that.  Apparently you don’t want better competition.  I will set it aside and listen to you.”


“Do so, Harry.  This is more important.  If it will assuage your feelings I’ll let you win a game or two.”


I deliberately plucked each piece from the board and placed them one by one back in the box, then sat back to listen.


“Harry, you are being childish.  But never mind that.  The Ameriplan may affect your future as a physician.  One thing is sure.  Everybody is coming up with a new plan on how medical care in the United States will be dispensed.  The Ameriplan is the American Hospital Association’s entry into the field, put forth in a 91 page booklet which can be obtained if you write to them at 840 Lakeshore Drive, Chicago, Ill. 60611.  The Ill., incidentally stands for Illinois, not sickness.”


“It sounds fascinating so far,” I offered.


“It is.  It is a comprehensive plan for the dispensing of what is called health care.  It is oriented to the maintenance of personal good health and the prevention of illness in contrast to the present system which is primarily oriented to the treatment of illness after it becomes acute.”


“Sounds good,” I said, wondering when I would be able to get back to the chess game.   


“Well, if not good, interesting.  They propose to have federal legislation enacted which would require the adoption of federal regulations defining the scope, standards of quality, and comprehensiveness of health services and stating the benefits to be provided for all of the people.  These regulations would be administered at the state level with care being provided locally by the Health Care Corporation.  It gets even better as it goes along.  Listen.  ‘Each Health Care Corporation would synthesize management personnel, and facilities into a corporate structure with the capacity and responsibilities to deliver the five components of comprehensive health care to the community, health maintenance, primary care, specialty care, restorative care, and health related custodial care.’


“‘The proper growth of Health Care Corporations would only occur through the most appropriate economical use of all resources.  Enforceable regulatory controls would be established by legislation in each state to assure that needs would be met without unnecessary construction or duplication of services.  –All persons in the community would have a role in identifying how health services would be provided – To advance the development of Ameriplan, legislation must be enacted at the federal level.  This legislation would set forth the benefits to be provided under the Ameriplan. These regulations would define the scope, standards of quality, and comprehensiveness of health services, and would be administered by State Health Commissions.  In turn, the State Health Commissions would approve Health Care Corporations and authorize their operation.’”


“Sounds like someone is packaging oranges,” I said laconically.


“Funny you should say that, Harry.  The group that devised the plan was headed by a grocer.  The American Hospital Association offers a plan that provides for nothing less than a blue print for dictatorship.”


“But the credo of the United States, the right to life, liberty and the pursuit of happiness, includes I should suppose, health.”


“Of course, Harry, but not necessarily at the expense of liberty.  Under this plan legislation could be enacted to abolish cigarettes, alcohol, prostitution, and all the other evils that provide a little zing to life.  Not that I am for these things, mind you, but I have a feeling that the founding fathers included in their concept  of liberty, the privilege of foreshorten one’s life by indulging in harmful pleasures.”


“What’s your point, Simon?  After all, there’s nothing wrong with creating a system that provides for the health of the people.”


“It’s the manner by which it is provided, Harry.  After all, Ameriplan is nothing less than a gigantic bureaucracy.  It is health administered on a corporate basis.  It is the hospital system magnified a million times to include all interpersonal relationships.  It will convert medicine into a confrontation between the patient and a machine; between the patient and an administrative code book.  Look at the average hospital today.  The nurses have been diverted from patient care to satisfying a series of directives that tell how patient care should be performed.  Instead of nurses using their common sense to attend a patient’s needs, they must look first to obeying the rule books and completing the records so that inspection teams will be satisfied.   But more important, the system calls for one hundred administrators for every doctor.  Now I have nothing against administrators.  I just don’t like them.”


“That’s not personal, of course.”


“Not really,” said Lapius blandly.  “But since I can do their job and they can’t do mine, I feel the positions should be reversed.  They should be working for me.”


“That will be the day, Simon.”


“I guess you are right, Harry.  It seems more appropriate that doctors should be serving people who had a two year course in hospital administration, from a remote college in the valleys of the Teton range, that holds classes in the local church auditorium.”


“You don’t have to be sarcastic, Simon,”


He continued unabashed.  “I’m exasperated by the continuing attack on the medical profession, which although it practices to the highest standards of excellence, is blamed for the inaccessibility of medical service to large masses of people.”


“Are you saying that the capitalist system doesn’t work, that free enterprise is dead?”     


“No, Harry, I am just bemoaning the paradox that the free enterprise system spawned the highest level of medical practice in the world, but that the system will be socialized in order to provide its services to all Americans.”


“What alternative do you have?”


“Simple, Harry.  Give all Americans the money to purchase medical service at predetermined rates, but don’t destroy the uniquely random marketplace system that has provided the incentive between industry, the profession and the community, to produce the most sophisticated level of medical expertise in the world.  It would seem a shame, in order to distribute the high level of health care that is currently available, to have to kill the system that produced it.”


“In other words, why kill the goose that laid the golden egg?”


“Some would put it that way, Harry.”