ARTICLES

A DOCTOR’S CASE FOR STATE MEDICINE

The medical profession’s bitter fight against prepaid government medical plans is a losing battle for a wrong cause, an angry doctor contends. State medicine has to come, he says, for everyone’s sake—including the doctors’

HARRY PAIKIN August 22 1960
ARTICLES

A DOCTOR’S CASE FOR STATE MEDICINE

The medical profession’s bitter fight against prepaid government medical plans is a losing battle for a wrong cause, an angry doctor contends. State medicine has to come, he says, for everyone’s sake—including the doctors’

HARRY PAIKIN August 22 1960

A DOCTOR’S CASE FOR STATE MEDICINE

The medical profession’s bitter fight against prepaid government medical plans is a losing battle for a wrong cause, an angry doctor contends. State medicine has to come, he says, for everyone’s sake—including the doctors’

HARRY PAIKIN

THE ENERGETIC ORGANIZED resistance of Canadian doctors to any government - operated prepaid medical plan — or socialized medicine if you like—• seems to me to have suicidal overtones, like a burning ship that blindly fires on the rescue craft. Every modern historical and sociological trend makes it clear that socialized medicine is coming. Whether quickly and smoothly or with agonizing delay is partly up to the doctors. But quite apart from anything it will do for their patients, it will be the best thing that ever happened to the doctors themselves — especially if they have the wit to join enthusiastically in its planning.

Doctors who spent their time and money fruitlessly to fight the government's prepaid plan in Saskatchewan, and those who have sworn to resist elsewhere, seem to believe they're standing up for their rights. In a sense, they are. They're standing up for:

■ The right to spend much of their time acting as unpaid investigators for private medical-insurance companies, by answering endless questions that probe the patient's ability to w'ork—keeping for this purpose mounds of otherwise useless records.

■ The right to work sixty or seventy hours a week while most people work.

forty, and to enjoy vacations without pay.

■ The right to pursue uninsured defaulting patients through the frustration and embarrassment of the collection agency and the small-claims court.

■ The right to be asleep on their feet and only half-efficient at day’s end, largely from doing work that nurses and technicians could do.

■ The right of young doctors who lack connections to starve before building up a practice.

■ And the traditional inalienable right to feel that all this somehow makes them dedicated, although what they’re dedicated to is questionable.

In short, under the system they dismiss as socialized medicine, among the lives the doctors save will be their own.

Yet there is no doubt that these medical men, with isolated exceptions, are both prepared and determined to fight an allinclusive plan of socialized medicine right down the line.

The Canadian Medical Association, at its latest convention, drew up an ostensibly progressive statement of belief about prepaid medical plans. Demonstrably shaken by the defeat of old-line organized medicine in Saskatchewan, the CMA purported to believe that “insurance to prepay medi-

cal costs should be available to all regardless of age, state of health or financial status.” Unhappily, it hedged this highflown sentiment with so many qualifications— for example, fees must be set as before by “negotiation” between doctor and patient—that the statement of belief became meaningless. Or, rather, its meaning became all too clear — no workable government-operated plan is acceptable to the CMA.

Why not, if such a plan will benefit doctors in the long run? I shall consider in a moment their various specific, though specious, arguments against socialized medicine, but the underlying cause of resistance is that most doctors are overstuffed with scientific and clinical fodder and have had a pitifully meagre sprinkling of the humanities or other cultural subjects since highschool days. Medical schools have no time for “such twaddle.” In dealing with economics, sociology or politics, many doctors remain babes in the woods. Myopically, they persist in seeing medicine as a business, where you sell so much healing skill for so much recompense, instead of as a public service to which every citizen has a right, like education or police protection.

Instead of bringing the medical picture into historical focus in a changing society,

Dr. Harry Paikin has been in general practice since 1931 in Hamilton, Ontario, where he is a member of the Board of Education and the Board of Health, and a former chairman of both bodies. He is also president of the Ontario Urban and Rural School Trustees’ Association, and a member of the American Academy of Dermatology and Syphilology.

in a way the teaching profession, for instance. has accepted, the medical profession has refused to acknowledge the twentieth century. My quarrel is not with any individual member of my profession, but with the philosophy of sociological intransigence by which organized medicine currently lives and acts.

Twenty-five dollars was extracted from many U. S. doctors in 1952 by those who supported Senator Robert Taft for the Republican presidential nomination, because Taft seemed the only candidate in cither major party reactionary enough to suit many doctors. Taft was foursquare against creeping socialism. This seemed to the Saskatchewan College of Physicians and Surgeons such a worthwhile scheme that they took a hundred dollars from each of their members to fight Premier T. C. Douglas in I960. Like the Taft supporters, they lost. The money was poured into a public-information campaign so patently intemperate and exaggerated that Douglas and his CCF government were elected on a platform of socialized medicine, despite all the doctors could do.

But the arguments they used will bob up again, every time another province seeks to protect its citizens from the financial ravages of injury and disease. The doctors will say:

Socialized medicine creates a bureaucracy run by laymen. I say that after dealing with municipal, county and provincial medical societies, all run by doctors, we in the profession should be used to bureaucracy by now'. And what's so sinister about laymen? As our elected representatives, they run the whole country. What is a school board but a group of laymen in the field of education? And what about the Swift Current medical plan in Saskatchewan? Its top authority is a board of twelve citizens, and it's been commended by the secretary of the CM A.

But the patient's most intimate medical secrets will be exposed to government employees. Strangely enough this argument has never cropped up with respect to doctors who report to private insurance companies. Why be so sanctimonious in the case of a government plan? (In point of fact, a significant instance of government discretion is Ontario's abolition of any reference to legitimacy on its birth certificate.) Where hospital insurance is run by governments, the paperwork load is lighter, believe it or not. There are no questions about past illnesses.

// medical care is free, hypochondriacs will waste all the doctors' time. This hardly deserves an answer; seriously ill and needy people outnumber hypochondriacs a hundred to one. and. in any case, the novelty of running to the doctor for nothing is just as certain to wear off here as it has worn off in England.

Without the indigent free-ward patients,

teaching hospitals will have nobody to use as teaching material. Poor people, incredibly enough, are every bit as sensitive as rich people. What is the justification for subjecting medical-alms recipients to degradation and embarrassment at the hands of over-objective clinicians?

The patient should be free to choose his own doctor. Unquestionably. But free choice must not be contused with unlimited choice. Under any system, choice of physician is always limited by certain obvious factors. Take geography: if a Calgary woman's favorite doctor moves to Vancouver. there's not much she can do. And how much free choice is there when a patient has to go to a closed hospital, where his family doctor is not allowed to attend him? Only a working system of socialized

medicine can guarantee the widest choice of physician by removing the barrier of ability to pay.

Doctors will, in effect, become civil servants taking a government salary, and they may earn less. I his is the crux of the whole problem. The very fact that it worries doctors so much is a sad commentary on the state of their economic education. In this respect they have much to learn from teachers.

Doctors have some lean years behind them as students and interns. They want to get their dough back. Organized medicine has been saying for years that it is non-political—and therefore the festering public-health problems it ignores aren't its business-—but once the issue became gilttinged, once the doctors thought their wallets were threatened in Saskatchewan, how quickly they dropped their threadbare coat of neutrality.

Some specialists in England are actually earning more today than they ever did without socialized medicine. But will even the average Canadian practitioner find himself less secure financially under a prepaid medical plan? Look at him today. He doesn’t have the low-cost insurance and pension benefits available to nearly any

factory hand: he has no minimum work week: no guarantee the patient will pay him promptly, or at all. and no job security until years after he graduates from university, unless he's a hereditary member of one of the cliques that form around the closed teaching hospitals.

In addition to what a government-operated plan will guarantee patients, it must contain guarantees for doctors. In other words, it's time the doctors stopped fighting socialized medicine and started demanding that it be brought along quickly, and with them in mind.

Of course, doctors will protest that they like their current working conditions, that they love filling out all those repetitive forms, that they delight in losing fifty cents on a five-dollar house-call fee because the private insurance carrier is so top-heavy with clerical costs. Doctors will say they don't want anybody to dictate to them how many hours they should work.

Then let us ask: how safe is a doctor punch-drunk with work? Is he not a menace both to himself anil to the patient? Should not a progressive system of medicine seek to save both doctor and patient? There will be doctors who die because of dedication and some who die because of greed.

If so many doctors work such long hours today, who will do the extra work when they're all on the forty-hour week? Much of the time of any busy doctor is eaten up by clerical and routine drudgery far below the level of his true medical competence. 1 he answer lies in more medical education-—not merely of doctors, but of the nurses and technicians who should he shouldering the less highly skilled work. (When a medical student flunks out. why don't we at least educate him as a medical technician instead of writing him off?)

Education and health, freely available to all. are the two pillars that will support for Canadians the ancient ideal of healthy minds in healthy bodies. We've built two thirds of the educational pillar—free compulsory primary schools and free secondaryschools. If we go on. if we educate university students including medical students free of charge—even paying students a salary if they need it—we'll have the whole pillar built. Howmany deserving students would we salvage with such a system?

This would make it easier to build the second pillar of universal health, on which we've made hesitant beginnings with our medical welfare plans, our hospital insurance. our free tuberculosis X-rays and our free Salk shots. A young doctor assured of security, who hasn't had to endure grinding penury as student and intern for eight or nine years, will surely be more likely to remember one of the high concepts of his profession: Non magister sed minister — Be not the master but the servant of humanity.