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However broad the Blues and commercial health-insurance companies may become, they are still likely to suffer by comparison with prepaid group-practice plans on two key issues: hospitalization and surgery. In 1966, the Blues tallied 876 patient-days in the hospital per 1,000 subscribers (excluding maternity cases), while the group-practice plans had only 408. Blue Shield subscribers had 73 surgical procedures per 1,000, while the groups' subscribers had 31. For tonsils and adenoids the disparity was still greater: 8.4 v. 1.9.
Now both the Blues and the commercials are being crowded by Medicare. Despite the long years of angry controversy that preceded its enactment, Medicare has caused no upheavals in medicine generally. Hospital admissions of oldsters have increased, in most areas, by no more than 5%. True, hospitals that used to do much charity work—and treated their patients as charity cases—are losing these patients to voluntary hospitals. For the first time, they have a choice.
Physician's Assistants
Less than two years ago, the A.M.A.'s then president, Dr. Milford O. Rouse of Dallas, sputtered against what he considered the heresy of regarding medical care as a right rather than a privilege. "Today," says Walter McNerney, president of the national Blue Cross Association, "it is firmly accepted that no one is going to be without care who needs it. That battle is over." The questions then are: How shall it be delivered? How will it be paid for? And how good will it be?
There is a growing consensus that the best method for delivery is "the satellite system." At the center of each system would be a university medical school with its affiliated hospitals, or some medical center like the Mayo Clinic, which may not be part of a medical school but has equal standing. The first ring of satellites would be community hospitals. The second ring would be community health centers, some along the lines of the Office of Economic Opportunity centers now operating in such disparate places as Boston, Mass., and Mound Bayou, Miss. (TIME, Nov. 29). These centers could have their own satellites; in areas where distances are great and people are few, they might be manned by a "physician's assistant," a new breed of paramedical personnel with skills and training equivalent to those of medical corpsmen in the Armed Forces.
To get satellite systems into their proper orbits, regional planning is a necessity. A few areas have voluntarily begun such planning. For the rest, says Houston Surgeon Michael E. DeBakey, it may be necessary for the Federal Government to set rules and enforce them. One area plan has been started by the University of Oklahoma without such prodding and will cover the state. Its clinics, like one now operating in Wakita, will have three doctors: a general physician, a pediatrician, and one for obstetrics and gynecology. With three men on duty, one of them can always get away for vacation or refresher courses. They will have ready access to the medical center's battery of specialists. The three doctors agree to stay for a specified number of