Medicine: The A.M.A. & the U.S.A.

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¶ Palo Alto Clinic. It runs several plans, including one open to Stanford University students and faculty, makes money with enough left over for experiments. It is now starting a pilot plan for 500 over-65 couples, offering full medical, surgical and hospital care for $20 a month.

That physicians can do it themselves, with no third party intervening or insurance company overriding, is shown by a bold experiment that has been running for 23 years in Oregon. This is an attempt to combine solo practice (which many A.M.A. members still prefer), fee for service, free choice of physician and full prepayment. Sponsor of the plan is the Physicians' Association of Clackamas County (pop. 113,000), adjoining Portland. Every physician practicing in the county is eligible to join, and all have done so. Every resident is eligible, at $7.50 a month, to receive whatever medical and surgical services he needs. He chooses his own doctor. When he gets treatment, the doctor sends the bill to the P.A.C.C. If illness has been running at average rates, the doctor gets his full fee, according to a set schedule. If there has been a lot of illness, so that charges outstrip premiums collected, the doctors take a proportionate cut.

A major objection to panel practice is that the traditional, one-to-one patient-doctor relationship may be weakened. Yet, says Atlanta's Dr. Arthur P. Richardson, a doctor in a group can have just as much interest in his patients as any other: "The corner grocery store is gone, but people in supermarkets can be friendly too." Says Dr. Joseph C. Hinsey, director of the giant New York Hospital-Cornell Medical Center: "Group practice is the most efficient type in the long run." New York University's Dr. Howard A. Rusk goes farther: "Solo practice is outdated, as outdated as fee-for-service. You have to have groups. No one doctor is smart enough to know enough about the entire skin and all that it covers."

Ingenious plans, flowing out of the American sense of compassion and justice, seem certain to spread in the U.S., probably holding the expansion of Government-run medicine to the role of filling in a dignified way the needs of those who are not otherwise covered. The A.M.A. will undoubtedly continue to promote medicine of the highest standards, and it may also learn to accept changes in the doctor's economic status with more grace. At its May meeting, the dynamic California Medical Association urged A.M.A. to take the lead in efforts to make prepaid medical care available to all U.S. citizens. President Larson, in his inaugural address last week, said: "The professional spirit emphasizes conformity to the principles of scientific truth and ethical conduct. It also recognizes the rights and potentialities of the rebel or maverick who may have a new idea, a different method, a fresh viewpoint."

*And in 1923, was TIME'S first medical consultant; 72 this month, he is now a prolific medical columnist and editorialist, and editor of Medical World News.

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