(See Cover)
U.S. medicine matches any in the world and tops most—a fact that, wholesomely enough, leaves U.S. doctors eager to make it even better. To improve the distribution of good treatment, the organization of medicine is in a state of headlong change, from stressing the general practitioner and his elastic fee to stressing group practice by specialists with most costs prepaid. Last week the American Medical Association, a group not prone to accept change gladly, acknowledged the trend by installing as president a group-practice specialist who says that "medicine cannot be blind to social change."
Dr. Leonard Winfield Larson, 63, a short, folksy pathologist from Bismarck, N. Dak., will not lead A.M.A. down any radical paths; his denunciations of socialized medicine ring as loud as anyone's. Yet he is known in the organization for taking a step that a decade ago would have seemed unthinkable to A.M.A. After heading an investigating commission, Larson two years ago got A.M.A. to affirm the economic merits and medical quality of prepaid, closed-panel health-care plans —typically. New York's Health Insurance Plan (H.I.P.).
Such plans infringe on A.M.A.'s oldest tenets: that doctors should be paid a fee for each service and that patients and doctors should choose each other freely. Fully organized health plans collect from patients on insurance principles, pay their doctors salaries or shares, and assign patients to qualified specialists. A.M.A. fought group plans for years; the surrender was a belated recognition by A.M.A.'s scientific element that these systems can and do give good results. Out of such challenges and accommodations comes 1961's ferment of change in the relation between doctors and patients.
A Better Buy. The biggest factor in the change is the wholesale advance of medical science that makes modern medi cine more expensive but a better buy, with far more certain diagnoses, routine complex surgery, and virtually sure cures for many ailments. This represents a remarkable change. Harvard's late Professor Lawrence J. Henderson noted that not until 50 years ago did a random patient taking a random disease to a random doctor have better than a fifty-fifty chance of "benefiting from the encounter."
Beginning with insulin for diabetes (1922), the benefits from an encounter with the doctor have grown at an ever faster pace. The microbe-killing sulfas came along in time to be dusted into the wounds of hundreds of thousands of servicemen in World War II—and were in turn pushed aside by antibiotics such as penicillin (1945) and tetracycline (1953). Tuberculosis and some forms of pneumonia were brought under control. Virus diseases have resisted cures, but medicine developed effective vaccines that drastically curbed more of them—notably influenza and poliomyelitis.
Perfecting of methods to store blood made transfusions routine and cut the costs. Surgeons learned how to open and repair a blue baby's heart, use plastic replacement parts—and taught skilled techniques to enough other surgeons so that a doctor like Walter M. Boyd of Greeley, Colo., can say: "I regularly perform operations never heard of 25 years ago. At our little hospital we have four or five men who can handle just about anything that comes along."