The Medical-Industrial Complex

Men, Money and Medicine

by Eli Ginzberg, by Miriam Ostow
Columbia, 291 pp., $8.50

The American crisis over health has finally taken a place alongside the urban crisis, the ecological crisis, and the “youth crisis” as the subject for solemn Presidential announcements, TV documentaries, and special features of magazines ranging from Fortune to Redbook. But to the average consumer of pills, hospital care, and doctors’ services, the crisis in health care is nothing new, except that the stakes—health, beauty, and life itself—get higher with each advance in medical technology, from miracle vaccines to organ transplants. The odds against the sick are high, and getting higher all the time.

Health care is, first of all, a scarce and expensive commodity. With the increasing centralization of medical manpower and modern equipment in a few big city medical centers, rural areas, small towns, and urban ghettos have been left empty of even the most rudimentary, old-fashioned services. Where services exist, their high cost is the most serious barrier to health care, not only for the very poor, but for growing numbers of working people as well. As the price of medical care mounts, health insurance has become a necessity; but insurance premiums are becoming more expensive too, while benefits dwindle as rapidly as the costs of medical treatment increase.

Money aside, the consumer’s major problem is finding his way about an increasingly impersonal, fragmented, irrationally arranged set of health services. The patient, rich or poor, treks from specialist to subspecialist, from clinic to clinic, from doctor to laboratory, losing more money and time at each stop. No one is concerned with the general state of his health, as opposed to his immediate illness; fewer and fewer doctors are even concerned with the patient’s whole body, sick or well. Long waiting times and brusque service are now almost as characteristic of private doctors’ offices as they are of the hospital clinics used by the poor. And for the very poor, usually black and brown people, the price of care in a hospital’s “charity” ward or clinic is often the humiliation of having his body used as “material” for research and the training of doctors.

The health care itself that the American consumer receives is, in most cases, barely adequate. Despite our uncontested prowess in medical technology, mortality statistics are shamefully high: The US ranks fourteenth among the nations of the world in infant mortality rates, twelfth in maternal mortality, eighteenth in male life expectancy at birth (all figures 1967). More detailed studies show the same bleak picture. For example, a 1964 study sponsored by the Teamsters revealed that no fewer than 40 percent of the New York hospital patients surveyed, all of them Teamster members and their families, were receiving “less than optimal” medical care. Thus, the social cost of the American medical crisis is not just discomfort; it is lives.

The Kennedy-Johnson administrations discovered the health crisis in the early Sixties, at just about the same time they discovered poverty, the neglect of the old, racism, and some of the other indignities …

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Letters

To the Health Barricades April 22, 1971