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
“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.”