A quiet revolution is occurring in the American medical profession. This subject is examined at length in THE WORLD & I Modern Thought sections this month and is perhaps the most important issue we have presented to our readers. This revolution, which affects each of us in terms of our health, our relationship with our doctors, and our economic well being, will have far greater impact on individual Americans than will the transformations that are occurring in the former communist world.
When I was young, there were no health plans. Today most Americans are covered by medical plans that are part of their work benefit. When I was young, most Americans had a doctor who was a general practitioner in independent practice. Today, increasing numbers of Americans are members of health maintenance organizations (HMOs) that have large numbers of doctors as paid employees. Permission increasingly is needed for elective surgery, and treatment often is determined by general rules of insurance organizations rather than by the circumstances of the individual case.
It does not follow that everything about the old system was good and everything about the new system bad. If HMO's put increasing pressures on doctors to produce profits, the old system produced large numbers of unnecessary hysterectomies, for instance, and kickbacks for referrals. I do not know where the balance lies, although I am disturbed by the concept of doctor as corporate employee. And we all are, or at least should be, disturbed by the increasingly large share of the GNP that is going into medicine.
We need more information on what is happening in medicine and we need to develop a
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