The Doctor Glares at State Medicine

A witty reflection of the doctors' views of socialized medicine and healthcare reform in 1944.

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In 1944, doctors worried that socialized medicine, as proposed in the Murray-Wagner-Dingell bill, meant ruin for their profession. If readers doubted this, Frederic Nelson encouraged them to ask their family physicians.

[See also: “Fixing Our Healthcare System” from our Sep/Oct 2012 issue.]

December 9, 1944—Your recent doctor’s bills probably shared the envelope with a leaflet warning you against “socialized medicine.” The leaflet, sponsored by the National Physicians Committee, explains that, if anything like the Murray-Wagner-Dingell Social Security Bill passes, doctors will become state jobholders with no more personal interest in your tonsils than could be expected of the clerk of bills at the city hall. Friends of the medical-care sections of the Wagner Bill protest that the National Physicians Committee doesn’t really represent the docs, but the fact remains that your family doctor, who is wearing himself out by his efforts to spread medical care as far as he can, thinks his number is up.

Right or wrong, this is what most doctors think, and if you doubt it, the thing to do is ask your doctor. He will probably talk your arm off, but after all you get a $250 amputation for nothing. I can testify that there is no better way to outlast the other patients in the waiting room of a doctor’s office than to stop saying “Ah” long enough to introduce some such line as this: “Doctor, I heard on the radio the other night where a fellow was explaining that only reactionaries were against this Wagner Bill.” I have tried this topic on all sorts of doctors, from orthopedists to the plain general practitioner (G.P. Joe, as I suppose he will be known from now on). The result is practically always the same. My researches indicate:

  1. That American doctors are against socialized medicine or any modification thereof which subordinates them to bureaucrats, makes them salaried officials, or interferes with their professional standards.
  2. That American doctors are definitely interested in making medical care available to more people, and in plans to pay doctors’ bills on the insurance principle—provided such plans are nonpolitical.

The fact that any group should want anything else is a complete mystery to the doctor. He is driving himself at top speed to meet the demands on him, and is baffled by sociologists who think he could trot from bed to bed faster, if only the Federal Government would take over. Caught off guard, he is likely to give you something like this:

“You pay for your groceries, give the landlord his monthly check, and pay the undertaker a fabulous sum to bury you. But just let the doctor identify a strep infection in time, fix you up with the proper sulfa drug, and send you a bill for $28, and down you sit to write to your congressman demanding that doctors be sovietized and medical expenses subsidized by the state. I don’t get it.”

You say, if he hasn’t shut your face with a clinical thermometer: “But, doctor, there are a lot of people who simply can’t pay medical bills. Furthermore, even the average middle-class man with a good salary is knocked for a loop if he is hit by a $500 operation that keeps him from work for a couple of months. Nobody is blaming the doctor or expecting him to support his patients when they are flat on their backs. The problem is to find a way to help people pay for medical care, so that the doctor won’t have to treat the poor for nothing, hoping against hope to land enough rich men who don’t mind paying $2,000 to have an appendix lifted.”

Of course, your doctor hasn’t been listening. He has been waiting for you to stop talking, maybe snapping a nose elevator in the air to calm his nerves.

“You mention the people we treat free in clinics. Do you know what will happen to them under state medicine? In our clinic they get the attention of the best men in the profession. When Wagner and Murray get through with medicine, no doctor of any standing will ever see such a patient. Why? Simply because there will be a fee attached, and you can be pretty sure that some shyster with a brother-in-law at the city hall will grab all those cases.”

“All right, all right,” you interrupt, pushing aside the stethoscope, “but something has got to be done.”

“Sure,” agrees the doc, “but understand at the outset that you are dealing with the services of highly trained professional men and not with something you can dish out over the counter at the supermarket, or, if the customers can’t pay, through the Surplus Commodities Corporation.”

Let’s not assume from all this that the doctor has done nothing to meet new conditions. Actually, he has done quite a lot to put himself on a semi-collective basis. The individual doctor can no longer afford to equip himself with all the expensive machines and gadgets used in modern practice. If he lives in a city, he probably works around a hospital where he can treat his very sick patients and consult with other doctors on cases that puzzle him. If he is a country doctor, he does the best he can. Doctors have for years grouped themselves together to feed an assembly line of diagnosis and treatment without benefit of politicians. The trouble is that relatively few laymen can afford this attention. Some crotchety doctors think the patient isn’t missing much.

Because modern medical care is expensive, we have free clinics, special arrangements for the middle-class poor, and a gradual extension of treatment in hospitals at standard prices. Recently, a writer in Medical Economics protested that hospitals were providing too much medical care administered by salaried doctors and thus presenting a menace worse than “socialized medicine.” Obstetrics at flat rates, X-ray treatments, salaried anesthetists, and tonsillectomies “packaged to include surgical as well as hospital costs in one fee” were among the marketing schemes complained of. “It is time the medical profession prepared to defend the stand to which it gives lip service,” said the article. “It takes more than strong language at the AMA meeting once a year to turn the tide. We are approaching a day when physicians will be merely a class of skilled laborers, readily hired and fired by their community medical centers.”

To the man in the doctor’s waiting room this sounds like the corner grocer worrying about the supermarket. The layman is indifferent to the dilemmas of doctors because he isn’t familiar with them. At any rate, he was before the National Physicians Committee began its campaign to tell the customers how state medicine would affect them. The committee reports that its surveys reveal a trend away from socialized medicine as a result of the family doc’s mild words in his own behalf.

The patients never wanted state medicine anyway, but only some sort of prepayment scheme which would make it possible for a man of modest income to pay his own medical bills. Actually, the doctors want this too. They welcome patients who carry health insurance and many of them encourage and participate in group-insurance and group-medicine plans. But they don’t want a system, like that proposed in the Wagner Bill, in which the qualifications of doctors, educational standards, and the right to specialize in practice are determined by a board headed by the Surgeon General.

Because he isn’t much on politics, the doctor messed up his case pretty badly at first. Consequently, he got himself sued under the antitrust laws and pictured to the untutored as a leech who translates the oath of Hippocrates into English as “Never give a sucker an even break.” Actually, every man knows that his own doctor is a faithful and hard-working practitioner whose personal convenience is always at the mercy of his most capricious patient. We all know doctors who perform endless labors for nothing and treat the indigent as faithfully as their few wealthy customers. But so bad have been medical public relations that advocates of state medicine have succeeded in creating a doctor who doesn’t exist at all—a cold, calculating, selfish, reactionary politician whose object is to keep a very few people just well enough to pay exorbitant bills, but not healthy enough to dispense with the doctor. That picture, however, is changing. People are coming to find the bedside manner of Wagner, Murray, and Dingell a little unctuous.

The doctors have more to do—and I’m passing this along to the next doctor who treats me, if the door is handy—and that is to understand a little more fully than some of them do now that the public is not much interested in socializing them, but is genuinely concerned with the costs of medical care as a real problem in the lives of most people. Pari passu, the social planners may as well climb down from their high horse and interest themselves in the development of medical care on evolutionary lines, and by doctors, instead of a device to make doctors into political functionaries, thereby making the lot of the patients, including the poor ones, worse instead of better.

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