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