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Other comparisons are equally distressing. One involves disparities in the quality of medical care within the U.S., within states, cities, and between cities and rural communities. One man may get optimum care, while another who lives on the same street and enjoys the same access to medical facilities may be handled in wretched fashion. The greatest and least defensible gap of all is, in the words of Dr. Malcolm Peterson, chief of medical services at St. Louis City Hospital, "the wide disparity between the medicine that we know how to give and what we actually give. They're miles apart."
The Non-System
Why has American medicine failed to live up to its wondrous potential? The answer, says Dr. Philip Lee who was, until last week, top man for health in the Department of Health, Education and Welfare, is that the U.S. has no system for the delivery of medical care. To talk of the present system is ridiculous, he says, because it is a "non-system." What the U.S. has, according to Dr. Odin Anderson, of the University of Chicago's Center for Health Administration Studies, is a "pluralistic system" to match its pluralistic society.
The indirect but basic reason for this is that medicine is the only big business in which the ultimate consumer has no control over what he buys. The doctor prescribes the drug, for which the patient must pay, willy-nilly. He orders a hospital admission, and the patient rarely has any choice. The patient has no way of knowing whether he is getting good counsel from his family doctor, good drugs from his friendly pharmacist, good technical performance from his surgeon. For him, there is no Ralph Nader to blow the whistle on unethical practices. There is no ombudsman to represent him before some impartial tribunal. The tightly organized medical profession fends off any and all attacks from the outside, and in cases of complaints against any of its members, sits as prosecutor, judge and jury. It is the rare patient who even tries to protest an obviously excessive doctor's bill.-
Most U.S. physicians do not accept this bleak picture, and point to the undeniable excellence of medicine in many areas. Yet in many ways, the doctors themselves suffer from the lack of more rational organization in American medicine. For the most part dedicated and ingenious, they are usually overworked and harassed. They also have cause to complain of the patient's frequently faulty attitudes toward medical care. Some people, in all social strata, are simply afraid to admit that there is anything wrong with them; they put off seeking care until their disease is far advanced or even incurable. Some, especially among the poor and ill-educated, do not take advantage of care that is available to them. In a single borough of New York City, The Bronx, the infant death rate jumps 100% within five miles, going from north to south. The reason is sad but simple. The southeast Bronx is inhabited mainly by poor blacks and Puerto Ricans. Although excellent clinics are open for predelivery and infant care, it