Letter of the day, June 6

Controlling health care costs is not a new idea or concern, nor is the idea of universal health care. Also, I wonder if this is the beginning of the movement to have decisions about a patient's care made by hospital administrators?

John R. Mannix, the recipient of this letter, authored another article in the journal Hospitals (April 1944) where he states, "It has been confirmed and emphasized by every competent survey to date, including the Fortune poll, which showed that three-quarters (74.3 per cent) of all Americans believe the federal government should collect enough taxes after the way to provide for medical care for everyone who needs it."

From OHA 287, Registry of Noteworthy Research in Pathology

June 6, 1944

Mr. John R. Mannix,
Michigan Hospital Service,
Washington Blvd. Bldg.,
Detroit 26, Mich.

Dear Mr. Mannix:

Thank you for sending me the reprint of your article in the J.A.M.A. and also for having sent copies to Mrs. Bolton. I have read with considerable care your article on the Blue Cross. I particularly like the material under the heading Emergency is Here. I also favor the idea that such services should be interchangeable in the different parts of the country. I warmly approve your emphasis on the voluntary aspects of the proposal. There is one thought about your proposal which seems to me to deserve further consideration. You indicate that the provision of laboratory services and drugs, as well as the subscriber's stay in the hospital, should be left to the discretion and control of the physician. You know our experience here from your personal acquaintance with it. The selection of drugs should be made with care as to their exact purposes and relative costs. The exploitation of free laboratory services by the attending physician has been a real danger. The physician may also prolong the stay of a patient in the hospital for a variety of reasons not directly connected with medical care. Just how to control these possible disadvantages is a troublesome matter but that some sort of control should be exercised is certain. As you know, the vast majority of physicians are wholly considerate of their responsibilities to the organizations whith which they are connected but a few who allow other motives to influence their decisions may do harm. The greatest harm is not merely in their excessive requirements but rather in the influence brought to bear upon patients in their relations to other physicians. To delegate authority in this connection to administrative officers of the hospitals is not entirely without objection. There should, however, be some responsible group in the professional staff organization with authority to exercise control whenever necessary.

With best wishes, I am,
Sincerely yours,
Howard T. Karsner

Universal Health Care

Today's expected presidential signature on the health care bill is a huge change for America, but this issue is by no means a new one. In our Registry of Noteworthy Research in Pathology collection is an article by John R. Mannix, Director of Chicago Plan for Hospital Care, titled "Why Not an American Blue Cross? How Hospitals and Physicians, Cooperating, Might Provide Prepayment Health Services for All." It was written in 1944 in the journal Hospitals.

Mannix proposed that physicians and hospitals create an American Blue Cross and obtain a federal charter to operate in the federal interest. He says that in response to three things - the Depression's bringing to light the need for provisions against future need, strong Congressional lobbying for legislative protection by special interest groups, and taxes chipping away at individual fortunes that previously had been used for philanthropic purposes - the public was demanding guaranteed health services: "It has been confirmed and emphasized by every competent survey to date, including the Fortune poll, which showed that three-quarters (74.3 per cent) of all Americans believe the federal government should collect enough taxes after the war to provide for medical care for everyone who needs it." He goes on to say, "The public wants protection. One way or another it will get what it wants. It will accept, indeed welcome, a voluntary system, but meanwhile it is insisting upon the presentation of federal protection because it does not believe that voluntary agencies are going to do the complete job."

Sixty-six years later, it looks like his prediction will come about. It just took a little longer than he might have expected.

Walgreens and Quest partner up

Amid the bad news we hear about corporate America daily was some good - no, excellent news from the Walgreens drugstore chain and Quest Diagnostics. They are partnering to provide free basic health care through the end of the year to laid-off workers who have also lost their health insurance. Family members will also receive care if they don't have coverage elsewhere.

"Walgreens said patients who lose their job and health insurance after March 31 will be able to get free treatment at its in-store Take Care clinics for respiratory problems, allergies, infections and skin conditions, among other ailments. Typically those treatments cost $59 or more for patients with no insurance." Quest will offer free tests for strep throat and urinary tract infections.

Pretty excellent news and real community responsibility.

NLM lecture - Universal Health Insurance Provided by Government

Due to an overwhelming response, Dr. Reiser's lecture has been moved to NLM's Lister Hill Auditorium. All other details of the talk remain the same.


NATIONAL LIBRARY OF MEDICINE,
History of Medicine Division Seminar
Tuesday, September 23, 2008, 2-3:30pm
Lister Hill Auditorium, Bldg 38A, NLM
Bethesda, MD

"Universal Health Insurance Provided by Government: Explaining Historically Why America Has Resisted This Concept."

Stanley Reiser, MD, PhD, George Washington University

Since the founding of the United States, political and social values and events have exerted a telling influence on the structure of its health system and the division of responsibility for providing the resources to access its care. Lack of understanding the nature and significance of these developments has been a continuing source of the failure of proposals to enlarge the entitlement of Americans to health care, introduced in the 20th century and up to now. This presentation considers this history and the lessons it carries for us today.

All are Welcome

Sign language interpretation is provided. Individuals with disabilities who need reasonable accommodation to participate may contact Stephen Greenberg at (301-435-4995), e-mail greenbes@mail.nih.gov, or the Federal Relay (1-800-877-8339).

Due to current security measures at NIH, off-campus visitors are advised to consult the NLM Visitors and Security website:

http://www.nlm.nih.gov/about/visitor.html