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Staffing the satellites remains a problem, and the "physician's assistants" are probably the best solution. These men and women can replace doctors in some areas, and everywhere they can relieve doctors of time-consuming detail work. Much of this work, from filling out case histories to drawing blood specimens, they can actually do better than many a doctor. Duke University is the pioneer in training physician's assistants. It has 31 in its current two-year class, and will soon enroll 50. Three other schools have followed suit, and 50 are getting ready to do so. The numbers are still small, but if the experiment works, they can be rapidly expanded.
With added personnel, the U.S. annual bill for medical care will continue to go up, but more care will be delivered in return. How to pay for it will remain a problem at all levels. "All or virtually all Americans are now medically indigent," says Economist Pollack. "Health insurance for all has become a necessity." Dr. Philip Lee says: "The Federal Government will have to fill in the chinks of the private system. Private insurance does fine during the years when people are employed, but it doesn't do well for the aged or the unemployed. The Government must fill those needs." Before last November's election, Lee's former boss, ex-HEW Secretary Wilbur Cohen, had on his desk a plan to extend Medicare to provide "crisis care" for all Americans. Some suggest extending it to children, to the handicapped, and perhaps to all the indigent (Medicaid having proved to be no more effective than a bread poultice in most states). McNerney is pressing all Blue Cross plans to broaden their coverage. A practical man, he notes that merely shortening the average patient's hospital stay by one day would save well over $1 billion.
From Passive to Active
U.A.W.'s Reuther, once reviled but now widely lauded for boosting health insurance by building it into union contracts, keeps saying that he will soon announce plans for nationwide health insurance, but has offered no details. Senator Edward Kennedy is on record as favoring, in principle, some such proposal. No serious student of the U.S. medical scene believes that the nation is ready for—or would accept in the foreseeable future—a system like the British National Health Service. All current proposals envision the perpetuation of free enterprise in medical care—but a more responsible free enterprise system, with which the Federal Government and the states could enter into mutually profitable partnerships.
The voluntary programs are expected to predominate. There is increasing clamor from consumers for release from their passive, captive role and for an active voice. One who will support them is San Francisco's Berke, president-elect of the A.H.A. The association, he says, will soon set up a national consumer forum, and Berke would like to have it include not only representatives of con sumer groups like labor unions, but housewives and other individuals who have been through the medical mill as both patient and parent.
One of the most hopeful signs of change on the medical-care horizon comes from the young men and women who, three or four years